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Home My WebLink About20122089.tiff RESOLUTION RE: APPROVE TWENTY-TWO (22) CHILD PROTECTION AGREEMENTS WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with twenty-two (22) Child Protection Agreements between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and the various providers, commencing June 1, 2012, and ending May 31, 2013, with further terms and conditions being as listed within Exhibit "A," stated in said agreements, and WHEREAS, after review, the Board deems it advisable to approve said agreements, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the twenty-two (22) Child Protection Agreements between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and the providers listed within Exhibit "A," be and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreements. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 8th day of August, A.D., 2012. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Sean P. Conway, Chair Weld County Clerk to the Board William F. ar Pro-Tem BY: LW1`c�l` Deputy Cle to the Board �Iq EXCUSED I �a +a Barbara Kirkmeyer AP O D 1861 XCUSED avid E. Lo /� '�fi1�i ice►' /, C6 nty Attorney �%/e� A �X+ �orr-�o,�c/— �, Douglas ademac er Date of signature: (S'-DS I a orus Os-II ew vC ¢15 O 8'-39-/a 2012-2089 HR0083 1861 MEMORANDUM EXHIBIT 1311- i DATE: August 6, 2012 Q N T TO: Sean P. Conway, Chair, Boara of tunty om 'ssioners FROM: Judy A. Griego, Director, Human a ices De en r, SUBJECT: Child Protection Agreements for Services between the Weld County Department of Human Services and Various Providers Enclosed for Board approval are Child Protection Agreements for Services between the Department and Various Providers. These Agreements were reviewed under the Board's Pass-Around Memorandum dated May 7, 2012, and approved for placement on the Board's Agenda. There were a total of 52 agreements with various providers, one(1) provider withdrew their contracts leaving a total of 50 agreements; the following represent the next 22 agreements received leaving 6 agreements needing to be signed by the Board Chair. The major provisions of these Agreements are as follows: Program Area/ No. Provider Funding Source PY12-13 Rate(s) 1 Compliance Administrative Monitored Sobriety $13.00 (Urinalysis- Instant 5-Panel) Services, LLC Services $25.00 (Urinalysis - Instant 5-Panel Confirmation) 06/01/12-05/31/13 CW Admin $16.00 (Urinalysis - Standard Lab Test) $90.00 (Hair Test) $48.50 (Club Drug Panel) $40.00 (EtG) $40.00 (Spice Test) $40.00 (Bath Salts Test) $32.00 (Instant Saliva Oral Swab 4-Panel) $37.50 (Swab/Saliva Test) $2.00 (Breathalyzer) $2.00 (Breathalyzer Confirmation) 2 Counseling Services of Anger Management/ $25.00 (15 Contact Segments - Daily Longmont, Inc. Domestic Violence, Breathalyzers, Random Breathalyzers) Monitored Sobriety, $10.00(Urinalysis - 1 Drug Panel) 06/01/12-05/31/13 Substance Abuse $11.00(Urinalysis - 3 Drug Panel) $12.00 (Urinalysis -4 Drug Panel) CW Admin $13.00 (Urinalysis - 8 Drug Panel) $20.00 (Urinalysis- 10 Drug Panel) $20.00 (Retest per Drug) $50.00 (LSD Test) $35.00 (EtG) $25.00 (Saliva Test- 5 Drug Panel) $3.00 (Breathalyzer) $120.00 (Domestic Violence Intake) 2012-2089 $175.00 (Drug and Alcohol Evaluation with Intake) $200.00 (Domestic Violence Evaluation with Drug and Alcohol Evaluation) $100.00 (Anger Management Assessment with Intake) $60.00 (Anger Management Assessment without Intake) $30.00 (Group Session) $75.00 (Individual Session) 3 Griffith Centers for Children Mental Health Services $56.00/hr(Family Therapy) $52.00/hr(Individual Therapy) 06/01/12-05/31/13 CW Admin 4 Griffith Centers for Children Home-Based Intensive $48.00/hr(Home-Based Intensive Services) Services 06/01/12—05/31/13 Core 5 Griffith Centers for Children Life Skills $36.00/hr(Life Skills- Parenting Skills) $36.00/hr(Life Skills - Therapeutic 06/01/12-05/31/13 Core Visitation) 6 Idea Forum, Inc. Anger Management/ $55.00 (DV Intake and First Session) Domestic Violence $25.00 (Group Session, Adult) 06/01/12-05/31/13 $15.00 (Group Session, Youth) CW Admin $45.00 (Individual Session, Adult) $25.00(Individual Session, Youth) $50.00 (Caring Dads) $65.00 (Family Session) $150.00 (Anger/Domestic Violence Evaluation) 7 Idea Forum, Inc. Monitored Sobriety $8.00 (Swab) Services $15.00 (Urinalysis) 06/01/12-05/31/13 $40.00 (EtG) CW Admin $120.00 (Urinalysis- Steroids) $40.00 (Urinalysis - Synthetic THC aka Spice) $99.00 (Hair Test) $6.00/Week (Breathalyzer, 1-3/Week) $10.00/Week (Breathalyzer, Daily) $50.00/Month (Antabuse without Treatment) 8 Barry Lindstrom, PH.D., LLC Mental Health Services $325.00/hr(Evaluations) $125.00/hr(Ind. Therapy- Ph.D.) 06/01/12—05/31/13 Core $65.00/hr(Ind. Therapy- M.S.) $150.00/hr(Fam. Therapy- Ph.D.) $75.00/hr(Fam. Therapy- M.S.) $150.00/hr(Court Facilitation/Staffing/Case Consultation - Ph.D.) $75.00/hr(Court Facilitation/Staffing- M.S.) 9 North Range Behavioral Anger Management/ $200.00 (Anger Management or Domestic Health Domestic Violence Violence Evaluation) $35.00 (Group Session) 06/01/12-05/31/13 CW Admin $17.50/15 Minutes(Individual Session) 10 North Range Behavioral Functional Family $675.00/Month (Functional Family Therapy) Health Therapy 06/01/12—05/31/13 Core II North Range Behavioral Mental Health Services $250.00 (Level 1 - Behavioral Health Health Evaluation) Core $800.00(Level 2 - Partial Psychological 06/01/12-05/31/13 Evaluation) $1,200.00 (Level 3 -Full Psychological Evaluation) $1,800.00 (Level 4 - Extended Psychological Evaluation) $120.00/hr(Partial Evaluation Not to Exceed Cost of Full Evaluation, Court Facilitation/Facilitation) 12 North Range Behavioral Monitored Sobriety $20.00 (Urinalysis - 5 Panel) Health Services $20.00 (Urinalysis - 7 Panel) $20.00 (InstaCheck 5 Panel) 06/01/12-05/31/13 CW Admin $20.00 (Multi-Panel Instant Urinalysis) $20.00 (Instant Swab) $35.00 (GCMS -Confirmation) $5.00 (Breathalyzer) $100.00 (Hair Test) $50.00 (Patch) $30.00(EtG) $50.00 (Urinalysis - Expanded Designer Stimulants - 14 Panel) $35.00 (Urinalysis -3 Panel) $35.00 (Urinalysis - Spice) $35.00 (Oral Swab- Spice) 13 North Range Behavioral Multisystemic Therapy $1,800.00/Month (Multi-Systemic Therapy) Health Core 06/01/12-05/31/13 14 Savio House Foster Parent $56.00/hr(Foster Parent Consultation) Consulation 06/01/12-05/31/13 Core 15 Savio House Home-Based Intensive $1,600.00/month (HB/CBS Adolescents) Services $1,814.00/month (HB/CBS Child Protection) 06/01/12-05/31/13 Core 16 Savio House Life Skills $50.00/hr(Life Skills) 06/01/12-05/31/13 Core 17 Savio House Multisystemic Therapy $1,670.00/month (Multi-Systemic Therapy) $2,537.00/month (Multi-Systemic Therapy- 06/01/12-05/31/13 Core Problem Sexual Behavior) 18 Shiloh Home, Inc. Day Treatment Services $1,625.00/month(Day Treatment) 06/01/12-05/31/13 Core 19 Shiloh Home, Inc. Mental Health Services $95.00/hr(Family Therapy- In-Home) $75.00/hr(Individual or Family Therapy- In- 06/01/12-05/31/13 Core Office) $45.00/hr(Group Therapy) $90.00/hr(Psychological Evaluation) 20 Shiloh Home, Inc. Sexual Abuse Treatment $95.00/hr(Family Therapy - In-Home) $75.00/hr(Individual or Family Therapy- In- 06/01/12-05/31/13 Core Office) $45.00/hr(Group Therapy) $90.00/hr(Psychological Evaluation) 21 Turning Point Center for Home-Based Intensive $25.00/hr(Behavioral Coaching) Youth and Family Services $80.00/hr(Option B, Greeley Metro Area) Development, Inc. $120.00/hr(Option B, Outside Greeley Metro Core Area) 06/01/12-05/31/13 22 Turning Point Center for Day Treatment Services $89.00/Day(Day Treatment with In-home Youth and Family Therapy) Development, Inc. Core $79.00/Day(Day Treatment without In-Home Therapy) 06/01/12-05/31/13 $65.00/Day(Day Treatment- Transitional Services) If you have any questions, give me a call at extension 6510. PY-12-13-CPS-0098 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND COMPLIANCE ADMINISTRATIVE SERVICES,LLC This Agreement, made and entered into the IA -day of , 2012, by and between the Board of behalf Weld County Commissioners,sitting as the Board of Human Services, of the Weld County Department of Human Services,hereinafter referred to as the"Department"and Compliance Administrative Services, LLC, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS,required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Monitored Sobriety Services;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012, upon proper execution of this Agreement and shall expire May 31,2013,unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 1 PY-12-13-CPS-0098 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements,program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement,CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders,and all applicable standards, regulations,interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et.seq.and its implementing regulation,45 C.F.R. Part 80 et. seq.; and 2 PY-12-13-CPS-0098 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin,be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794, and its implementing regulations,45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq. and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment, declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records,making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CPS-0098 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state, and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et. seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3),if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and (c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety,Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PV-12-13-CPS-0098 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer, and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability c As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD) (Minimum). c Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). c CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. c Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals,insurance,etc.,required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CPS-0098 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. 6 PY-12-13-CPS-0098 c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Marc Pham Operations Manager Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego,Director Marc Pham,Operations Manager P.O. Box A 7100 Broadway q5-N Greeley,CO 80632 Denver,CO 80221 (970)352-1551 (3031 428-3849 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CPS-0098 19. Termination This Agreement may be terminated at any time by either party giving thirty(3) days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities,rights,benefits,protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer,member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition.During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation,CONTRACTOR shall 8 PY-12-13-CPS-0098 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation, renewal,amendment,or modification of any Federal contract,loan,grant,or cooperative agreement, 24. Storage.Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on-site visits, all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven(7)year period, or if audit findings have not been resolved after a seven(7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection,no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub-contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PV-12-13-CPS-0098 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, • development,trade secrets, business affairs,internal operations and management procedures and those of its customers,clients or affiliates, but does not include information(1)lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CPS-0098 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: �; a ' , BOARD OF COUNTY COMMISSIONERS r_:, WELD COUNTY,COLORADO Weld County Clerk to the Board tE61= w can P.Conway, Chair ,4, By: i r� AUG 0 8 2012 Deputy Clerk to a Board APPROVED AS TO FORM: 1 --(-)t (3-'4 0--et County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: Ju .Grie o, irector Contractor 0. 44/077. s Ti e ,� Q 11 PY-12-13-CPS-0098 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide timely and quality random monitored sobriety services to client referred by the Department. 2. The Department will provide"office space", located in the Weld County Department of Human Services' Building A,located at 315 North 11th Avenue,Greeley, Colorado,hereinafter referred as"the Premises", as follows: a. Department will provide one work space to the CONTRACTOR,as the Lessee,which will be located at the Premises. b. In consideration of leasing of the aforesaid,the parties covenant and agree as follow: i. The Department will charge no rent to the CONTRACTOR for use of the Premises; ii. CONTRACTOR agrees to use ordinary care when using the Premises; iii. CONTRACTOR may not sublet any part of the Premises; iv. CONTRACTOR may not use the Premises for any purpose other than conducting the business and duties under the Agreement; v. CONTRACTOR shall keep the Premises clean and in sanitary condition; 3. CONTRACTOR will present a professional image while on the Premises,including wearing neat and appropriate attire at all times. 4. CONTRACTOR will have a qualified monitored sobriety collector on site Monday through Friday,2-7 p.m., and will conduct random weekend monitoring two(2)Saturdays and one(1) Sunday per month, 10 a.m.-1 p.m.,or as modified by the Department. • 5. CONTRACTOR will only accept referrals when a client has been assigned a color and clients will be required to call in seven(7)days a week. 6. CONTRACTOR will only provide services to referred clients who provide picture identification. A caseworker may provide a client photograph in lieu of formal picture identification if such identification cannot be provided. 7. CONTRACTOR will have both male and female staff available,and will attempt to assign male clients on days when male staff are available. If male staff are not available, CONTRACTOR may opt to have the client complete a urinalysis and an oral swab for validation purposes. 8. CONTRACTOR may have a client complete a urinalysis and an oral swab if CONTRACTOR suspects the requested test may be compromised. 9. CONTRACTOR will not allow clients to make up missed monitoring unless prior approval from the Department is obtained. Either the caseworker or caseworker's supervisor may provide such approval. 10. CONTRACTOR will confirm any positive,negative or missed monitored sobriety within 24 hours through a phone call,test result,e-mail and/or fax to the Department(referring caseworker). 12 PY-12-13-CPS-0098 11. CONTRACTOR will provide a recap of each referred client's prior months monitoring by the 7th of the month following the month of service. 12. CONTRACTOR will submit the required monthly billing forms, result and client sign-in sheet(if applicable) by the 7th of the month following the month of service. 13. Results will be available online 24 hours per day, seven(7)days per week through the Norchem website (www. Norchemlab.com). 13 PY-12-13-CPS-0098 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $13.00/Episode(Instant 5-Panel Drug Screen) $25.00/Episode(Instant 5-Panel Confirmation) $16.00/Episode(Standard Laboratory Test) $90.00/Episode (Hair Test) $48.50/Episode (Club Drug Panel) $40.00/Episode(Ethylglucuronide/EtG Test) $40.00/Episode(Spice Test) $40.00/Episode(Bath Salt Test) $32.00/Episode(Instant Saliva Oral Swab 4-Panel Drug Screen) $37.50/Episode(Swab/Saliva Test) $2.00/Episode(Breathalyzer) $2.00/Episode(Breathalyzer Confirmation) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. 14 PY-12-13-CPS-0098 CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`r'day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 PY-12-13-CPS-0098 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost,protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social, emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORS must specifically document efforts to engage families in services and to control for safety. 16 PV-12-13-CPS-0098 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORS'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORS should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 • • PY-12-13-CPS-0119 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND COUNSELING SERVICES OF LONGMONT,INC. This Agreement,made and entered into the S -ay of//1?9,2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,on/behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and Counseling Services of Longmont,Inc., hereinafter referred to as the"Contractor". WITNESSETH WHEREAS,required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Anger Management/Domestic Violence Evaluation and Treatment; Monitored Sobriety Services; and Substance Abuse Evaluation and Treatment;and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit E"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 17(1 PY-12-13-CPS-0119 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit E of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement,CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including,but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards, regulations,interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et.seq.and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PV-12-13-CPS-0119 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R.Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex,religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(CRS.)26-6-104,requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. H. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records,making false statements,or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CPS-0119 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3),if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety,Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit D which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CPS-0119 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement,it has currently in effect all necessary licenses,approvals,insurance,etc.,required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CPS-0119 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. • 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. 6 PY-12-13-CPS-0119 c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Yolanda Cavazos-Pond Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Yolanda Cavazos-Pond, Director P.O. Box A 1129 Francis Street Greeley,CO 80632 Longmont,CO 80501 (970)352-1551 1303)772-3853 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy,reorganization and/or foreclosure. 7 PY-12-13-CPS-0119 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities,rights, benefits,protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of 8 PY-12-13-CPS-0119 interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation, renewal,amendment,or modification of any Federal contract,loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection,no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CPS-0119 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets,business affairs,internal operations and management procedures and those of its customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CPS-0119 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: �/� y„ ,C\ BOARD OF COUNTY COMMISSIONERS F � 1 WELD COUNTY,,COLORADO Weld County Clerk to the Board / �•, v { //7 Sean P.Conway,Chair By: — AUG 0 8 2012 Deputy Clerk t e Board APPROVED- OF / AS TTOFORM: I County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By:, / �2'n Y-62',14/111 akr A.Grie o,Director Contract Are ienr Title 11 PY-12-13-CPS-0119 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Anger/Domestic Violence Evaluation and Treatment;Substance Abuse Evaluation and Treatment;and Monitored Sobriety Services to adult clients referred by the Department. 2. CONTRACTOR will provide services at 1129 Francis Street,in Longmont,CO. 3. Anger Management treatment is a 12-24 week curriculum based upon the client's identified needs. 4. Domestic Violence treatment is provided as mandated by the Colorado Domestic Violence Offender Management(DVOMB)Standards. Level A(Low Risk): - Psycho-educational Treatment—One(1)90-minute session per week - 36 week educational curriculum - First treatment plan review within two(2)to three(3)months - Second treatment plan review within two(2)to three(3) months of the first review Level B(Moderate - Open ended psycho-educational treatment—One(1)90 minutes Risk): session per week - 46 week educational curriculum - One adjunct therapy per month required. - First treatment plan review within two(2)to three(3) months - Second treatment plan review within two(2)to three(3)months of the first review Level C(High Risk): - Open ended psycho-educational treatment—One(1)90 minutes session per week - 46 week educational curriculum - One weekly skills group required. - First treatment plan review within two(2)to three(3)months - Second treatment plan review within two(2)to three(3) months of the first review 5. Monitored sobriety results will be reported through Sterling Laboratories and will be available within 48 hours. Both positive and negative results will be faxed to the Department at(970)346-7667 since results cannot be accessed directly online. Additionally,the referring caseworker will be notified immediately by phone call,e-mail or fax if results are positive. 6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 12 PY-12-13-CPS-0119 8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. 10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CPS-0119 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2,below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $25.00/15 Contact Segments(Antabuse, Daily Breathalyzers and Random Breathalyzers) $10.00/Episode(UA- 1 Drug Panel) $11.00/Episode(UA-3 Drug Panel) $12.00/Episode(UA-4 Drug Panel) $13.00/Episode(UA-7 Drug Panel) $20.00/Episode(Retest per Drug) $35.00/Episode(Ethyl Glucuronide Test-EtG) $50.00/Episode(LSD Test) $25.00/Episode(Saliva Test-5 Drug Panel) $3.00/Episode(BA-One Time) $175.00/Episode(Drug and Alcohol Evaluation w/intake when necessary) $120.00/Episode(Domestic Violence Intake) $200.00/Episode(Domestic Violence Intake with Drug and Alcohol Evaluation) $100.00/Episode(Anger Management Assessment w/intake when necessary) $60.00/Episode(Anger Management Intake) $30.00/Episode(Group Session) $75.00/Episode(Individual Session) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible,but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 14 PY-12-13-CPS-0119 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit E. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit E of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 • PY-12-13-CPS-0119 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential,prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-12-13-CPS-0119 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate,CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-12-13-CPS-0119 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received,carefully review the referral for service information,client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services(visitation, therapy,home-based, etc.)are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 18 PY-12-13-CPS-0119 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date(appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only,should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7`h of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online(if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-12-13-CPS-0119 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services(Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. 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E a I E Cr J N vO > Q Z I yO ea - - O C } d u m ao i.) 0 c ,J C .9 V M O U C 0 , fV •> oa y Z .0 N I I G v 0 ..;..1 - p a, ar m U C ; O O I I -u a1 -' C O .. d m x L v a T O w a., 0 a v d o Q 01 $ y v rI ii .-i O > 0 E O a E E G m u !- "O U O V .92 u a, a) " } .Z n .0 ►- t�J Z a a o d v a Z tr1 O a Z U O o r--i O u = u 7 z r c c N , 'a c Z' L O a, n a) E r--1 V N fo f., u I .o c t .E Jo t p o ar et 2 7 ii a` = u" Zs { 1 2 '$ PY-12-13-CORE-0185x3/ /Oav CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND GRIFFITH CENTERS FOR CHILDREN This Agreement, made and entered into the It day of 2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Servi ,on behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and Griffith Centers for Children, hereinafter referred to as the"Contractor". WITNESSETH WHEREAS, required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Mental Health Services(Therapy); and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which wil! be paid from Cure Services funding during the duration of this Agreement. 1 opG/d-ev)6'9 PY-12-13-CORE-0185 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders, and all applicable standards,regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et. seq.and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 • • PY-12-13-CORE-0185 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794, and its implementing regulations,45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin, and sex,religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended, proposed for debarment, declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records,making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CORE-0185 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a) has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and (b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3),if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S. 24-76.5-101,et seq.,and (c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Welt Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0185 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals,insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0185 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data, special analyses, on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. 6 PY-12-13-CORE-0185 c. Incorrect payment to Contractor due to omission, error,fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Ttle For Contractor: Christina Murphy Program Supervisor Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A. Griego, Director Christina Murphy, Program Supervisor P.O. Box A 8461 Turnpike Drive,Suite 100 Greeley,CO 80632 Westminster,CO 80031 )970)352-1551 1720)425-5510 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint, or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy,reorganization and/or foreclosure. 7 PY-12-13-CORE-0185 19. Termination This Agreement may be terminated at any time by either party giving thirty(3)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied, of any of the immunities, rights, benefits,protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence, clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0185 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation, renewal, amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal, and state auditors and representatives shall,during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven(7)years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven(7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR'S written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CORE-0185 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets,business affairs,internal operations and management procedures and those of its customers,clients or affiliates, but does not include information(1)lawfully obtained from third parties, (2)that which is in the public domain, or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0185 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: -'-1 BOARD OF COUNTY COMMISSIONERS °�: ,'Ra WELD COUNTY,COLORADO Weld County Clerk to the Board 1g64 k ) } o Sean P.Conway,Chair i c AUG 0 8 2012 By: Deputy Clerk to a Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: A.G ego, Di ctor Contractor n min Sup/W.50r Title / 11 0W%2- ao8 9 PY-12-13-CORE-0185 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Mental Health Services to individuals and families(all ages) referred by the Department,to address mental health and behavioral issues,as well as issues around abuse/neglect, reunification and/or trauma. 2. CONTRACTOR will provide services in the office or a client's home/community and can be utilized in conjunction with or as a follow up to in-home services. 3. Services are conducted by Master's level mental health professionals. Every effort will be made to maintain the same therapist if the client has previously received services in order to maintain continuity of services. 4. Intervention strategies include Behavioral,Cognitive-Behavioral, Family Systems, Play Therapy as well as Brief and Present-Focused. 5. Sessions are weekly unless otherwise directed by the Department. 6. Pager access 24 hours a day, 7 days a week. 7. CONTRACTOR is sensitive to family ethnicity,culture,values and beliefs. 8. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to, any physical,emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 10. CONTRACTOR will make at least three(3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 11. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 12 • PY-12-13-CORE-0185 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $56.00/Hour(Therapy-Family) $52.00/Hour(Therapy- Individual) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 13 • PY-12-13-CORE-0185 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social, emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 14 • PY-12-13-CORE-0185 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child, etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 15 PY-12-13-CORE-0185 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 16 PY-12-13-CORE-0185 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date(appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue, Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 17 PY-12-13-CORE-0185 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY BY CONTRACTOR: Date: t `��' CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. 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Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D"Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 PY-12-13-CORE-0183 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must-confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards, regulations,interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et seq. and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-0183 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et seq.and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 G.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible, as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals:\ i. Are not presently debarred,suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records,making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally, or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CORE-0183 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S.24-76.5-101, et seq., and (c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0183 Agreement. CONTRACTOR shall indemnify,defend, and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR,shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals, insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. S PY-12-13-CORE-0183 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses, on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. 6 PY-12-13-CORE-0183 c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Christina Murphy Program Supervisor Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A. Griego, Director Christina Murphy, Program Supervisor P.O. Box A 8461 Turnpike Drive,Suite 100 Greeley, CO 80632 Westminster,CO 80031 1970)352-1551 (720)425-5510 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint, or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0183 19. Termination This Agreement may be terminated at any time by either party giving thirty(3)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Partv Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0183 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation, renewal, amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CORE-0183 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs, internal operations and management procedures and those of its customers,clients or affiliates, but does not include information(1)lawfully obtained from third parties, (2)that which is in the public domain, or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0183 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: <1„1, BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO Weld County Clerk to the Board s • • '„""'4;. Sean P.Conway, Chair R � AUG 0820 By: Deputy Clerk to a Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT CONTRA R: OF HUMAN SERVICES C By: By: J A.brie o, Directo Co ractorp ��'/��'��',`'��`�'"�'' Title F 1 S i 11 6)(7/o? - aWcPj PY-12-13-CORE-0183 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home-Based Intensive Services(Family Preservation Services)for high-risk families designed to prevent out-of-home placements or prepare families for reunification,as referred by the Department. Target populations include: • Families who are in crisis or experiencing major struggles in functioning. • Families with you in the home who are acting out behaviorally or sexually. • Families with children and youth ages 0-17 years. • Children who are at risk for out-of-home placement,or transitioning back into the home from foster care, residential treatment, Department of Youth Corrections or other out-of-home placement. • Foster families with children or youth who meet the above criteria. • "Families"is defined as children and/or youth residing with parents,relatives,guardians or foster parents. 2. Family Preservation Services are modeled after the National Family Preservation Network's definition of Intensive Family Preservation Services(IFPS). IFPS is defined as: • "IFPS services are designed to support families in crisis in which children are either at imminent risk of placement or have been placed out of the home. The services are for birth and adoptive families and are effective as reunification services as well as for placement prevention." 3. The goal of the program is to keep children safe and avoid both unnecessary removal and long separations from family in out-of-home care. Aspects of the program include: • Services are flexible and individualized to each family. • The home-based model offers service delivery that overcomes barriers to service access and services are provided in the environment in which issues most likely arise. • Services are utilized to stabilize family functioning and address safety risks. This is done through teaching families to work with community agencies, appropriate parenting skills,stress reduction, problem-solving and increased communication skills. • Services are available 24 hours per day,7 days per week. • Services include 3-6 hours per week in the referred families' home. Services can be increased as needed. • Appointment times are flexible and include evenings and weekends. 4. Intervention strategies include: • Treatment goals that are mutually agreed upon by family,CONTRACTOR and other professionals involved with the family such as the referring caseworker. • Interventions aimed at the individual,entire family or appropriate community members. • A strengths-based psycho-educational model that focuses on skill-building. • Other skills areas includes anger management,problem-solving, household management,and accessing community resources. S. Average length of services is 2 to 6 months. 6. CONTRACTOR will coordinate and advocate with school systems,court and the Department. 7. Follow up services are available for one year after discharge to aide in long-term success with pre- approval from the Department. 8. CONTRACTOR is sensitive to family ethnicity, culture,values and beliefs. 12 PY-12-13-CORE-0183 9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 11. CONTRACTOR will make at least three(3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 12. CONTRACTOR will submit reports on a monthly basis for each active referral. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 13. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0183 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2,below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $48.00/Hour(Family Preservation Services) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 14 PY-12-13-CORE-0183 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential,prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-12-13-CORE-0183 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR'S service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-12-13-CORE-0183 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 17 PY-12-13-CORE-0183 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date(appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months,and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7`h of the month following the month of service in order to be processed for payment that month. Billing received after the 7`h of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided),2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue, Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CORE-0183 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 19 ai > m rn u o r Z W E L ! 4 U o � � � U N Q UN NIn toN A. 2 > ._ Md2 (D m j ?v ' ' ' .i ' ' dZN dr. 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L a, a,a 7 v ii c) p E O , G d a u- EVCC et v 8 -o r m O z w 2 w ? y V z a a 9 E O a a, I Y O E r a z r o i r u o a--I y ro > O z -+J ❑ Y C N m 'a c m N O I i u : _ , u ' I I i p ._+z a i 0 v. a = v z i _i_.— _0 ,6 - PY-12-13-CORE-0184 �v CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND GRIFFITH CENTERS FOR CHILDREN This Agreement,made and entered into the II day of 2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Servic o behalf of the Weld County Department of Human Services, hereinafter referred to as the"Department" and Griffith Centers for Children, hereinafter referred to as the"Contractor". WITNESSETH WHEREAS, required approval,clearance, and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Life Skills(Parenting Skills,Visitation); and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1.2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billine/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 2261/29 _0%08; PY-12-13-CORE-0184 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement,CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations,including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards, regulations,interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation,45 C.F.R. Part 80 et seq.;and 2 PY-12-13-CORE-0184 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations,45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 a seq. and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex, religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.5.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended, proposed for debarment, declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement,been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-12-13-CORE-0184 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101, et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and (b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(6). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101, et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3),if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law,(b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan (PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0184 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense, and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado, by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement,it has currently in effect all necessary licenses,approvals,insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0184 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses, on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. 6 PY-12-13-CORE-0184 c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Christina Murphy Program Supervisor Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Christina Murphy, Program Supervisor P.O. Box A 8461 Turnpike Drive,Suite 100 Greeley, CO 80632 Westminster, CO 80031 1970)352-1551 1720)425-5510 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0184 19. Termination This Agreement may be terminated at any time by either party giving thirty(3)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits,protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection,paragraph,sentence,clause, and phrase thereof irrespective of the fact that any one or more sections,subsections, paragraphs,sentences, clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer,member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of 8 PY-12-13-CORE-0184 interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress, an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation,renewal,amendment, or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven (7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection,no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-12-13-CORE-0184 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0184 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. Tom\ ATTEST: F BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO Weld County Clerk to the Board Ig5P, can P.Conway,Chair "r-- By: � AUG 0 8 2012 Deputy Clerk to a Board i APPROVED AS TO FORM: • E; .5 i < C County Attorney WELD COUNTY DEPARTMENT CONTRACTO : OF HUMAN SERVICES 1 M By: i�..�. . . �V� By: L ' J d A.Gri go, Dire or Con actor Title a 11 020/07 7&S?. • PY-12-13-CORE-0184 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Lifeskills(Parenting Services/Skills,Visitation)to families referred by the Department.Target populations include: • Parents or primary caregivers who need in-home parenting instruction and assistance with household management and accessing community resources. • Parents with children ages 0-17 years who are at risk of out-of-home placement. • Parents with children ages 0-17 years who are placed out of the home with relatives or in foster care. • Children who are transitioning back home from out-of-home placement. 2. Services include an intensive in-home model with an emphasis on the child's developmental needs,and a Parenting Skills Group. 3. The goal of the intensive in-home program is to improve parenting skills,and increase safety and stability in the home. Aspects of the program include: • Services are flexible and individualized to each family,and are based on assessment of parent and child strengths and needs. • Each referred family is assigned a LSP specialist who is trained in and specializes in parenting, child development,and life skills. The LSP assists parents/caregivers with basic parenting skills, household management, budgeting,organizational skills,and other day-to-day issues that impede the care and development of children in the home. • All safety risks are addressed immediately by the LSP. • The in-home model offers service delivery that overcomes barriers to service access and services are provided in the environment in which issues most likely arise. • Services are utilized to stabilize family functioning and address safety risks. This is done through teaching families to work with community agencies,appropriate parenting skills,stress reduction, problem-solving and increased communication skills. • Services are available 24 hours per day,7 days per week. • Services include 3-6 hours per week in the referred families' home. Services can be increased as needed. • Appointment times are flexible and include evenings and weekends. • Average length of services is 2 to 6 months. • CONTRACTOR will coordinate and advocate with school systems,court and the Department. • Follow up services are available for one year after discharge to aide in long-term success with pre-approval from the Department. 4. Therapeutic/Supervised Visitation services are available as an in-home model with the option of providing visits in a community setting or other location designated by the Department. Visitation services will focus on assessing the parent/caregiver's parenting ability and work with individuals to meet the needs of the children during visits. • Objectives of Visitation: i. Ensure child safety during visits. ii. Closely monitor parent/child interactions to ensure appropriateness. Hi. Improve parenting skills(effectively meeting the developmental needs of the child(ren)). 5. CONTRACTOR is sensitive to family ethnicity,culture,values and beliefs. 6. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 12 PY-12-13-CORE-0184 7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 8. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 9. CONTRACTOR will submit reports on a monthly basis for each active referral. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 • PY-12-13-CORE-0184 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $36.00/Hour(Parenting Skills) $36.00/Hour(Therapeutic Visitation) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 14 PY-12-13-CORE-0184 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. c Risk is the likelihood (chance, potential,prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social, emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-12-13-CORE-0184 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR'S service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-12-13-CORE-0184 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received,carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 17 PY-12-13-CORE-0184 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only,should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CORE-0184 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. 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CC § 2 1 _ C ® k | k \ / & A f g/ o i - | o { q 3 K L0 \ / ; k f , I !0f zH IlIHI - t| . i.��} i I , PY-12-13-CPS-0117 r 3 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND IDEA FORUM,INC. or a This Agreement, made and entered into the 6 ay of/7/�j{� 2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,orS behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and Idea Forum, Inc.,hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Anger Management/Domestic Violence Evaluation and Treatment Services;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 1 020/9—d0 • PY-12-13-CPS-0117 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders, and all applicable standards, regulations,interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 a seq.and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CPS-0117 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex, religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible, as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended, proposed for debarment, declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal, state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CPS-0117 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et. seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law,(b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County 4 PY-12-13-CPS-0117 Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado, by and through the Board of County Commissioners of Weld County,its employees and agents, shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement,it has currently in effect all necessary licenses,approvals,insurance,etc.,required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CPS-0117 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. 6 PY-12-13-CPS-0117 c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Marcela Paiz President/Chief Executive Officer Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Marcela Paiz, President/Chief Executive Officer P.O. Box A 2560 West 29th Avenue Greeley,CO 80632 Denver, CO 80211 1970)352-1551 (303)477-8280 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CPS-0117 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities,rights,benefits, protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fad that any one or more sections,subsections, paragraphs,sentences, clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of 8 • PY-12-13-CPS-0117 interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal,amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven(7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-12-13-CPS-0117 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets,business affairs, internal operations and management procedures and those of its customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 • PY-12-13-CPS-0117 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. • ATTEST: ,b BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO • Weld County Clerk to the Board )`"^ .- 1 '.= ` Chair Sean P.Conway, By: _ AUG 0 8 2012 Deputy Clerk t the Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES • By: By�.�. J A.Gne o, Director C t actor • Title • 11 PY-12-13-CPS-0117 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Anger Management and Domestic Violence evaluation and treatment services to South County clients referred by the Department. 2. Anger Management treatment is a 12-24 week curriculum based upon the client's identified needs. 3. Domestic Violence treatment is provided as mandated by the Colorado Domestic Violence Offender Management(DVOMB)Standards. Level A(Low Risk): - Psycho-educational Treatment—One(1)90-minute session per week - 36 week educational curriculum - First treatment plan review within two(2)to three(3)months - Second treatment plan review within two(2)to three(3) months of the first review Level B(Moderate - Open ended psycho-educational treatment—One(1)90 minutes Risk): session per week - 46 week educational curriculum - One adjunct therapy per month required. - First treatment plan review within two(2)to three(3)months - Second treatment plan review within two(2)to three(3) months of the first review Level C(High Risk): - Open ended psycho-educational treatment—One(1)90 minutes session per week - 46 week educational curriculum - One weekly skills group required. - First treatment plan review within two(2)to three(3) months - Second treatment plan review within two(2)to three(3) months of the first review 4. Completion of Domestic Violence treatment is solely determined by gaining and demonstrating competencies established by the DVOMB to reduce level of risk and need. 5. CONTRACTOR has four(4)approved Domestic Violence Treatment providers on staff including staff approved to work with female offenders. 6. CONTRACTOR is a licensed provider sensitive to multicultural issues and can provide all services in both English and Spanish. 7. Services are available in Denver,Aurora, Brighton and Thornton,CO. Hours of service for all sites are Monday through Thursday,9 a.m.-9 p.m.; Friday,9 a.m.-8 p.m.;Saturday,9 a.m.-1 p.m. 8. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 12 PY-12-13-CPS-0117 9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 11. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CPS-0117 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,201.3. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $55.00/Episode(DV Intake and First Session) $25.00/Episode/Per Person(Group Session-Adult) $15.00/Episode/Per Person(Group Session -Youth) $45.00/Episode(Individual Session-Adult) $25.00/Episode(Individual Session-Youth) $50.00/Episode/Person(Group Session-Caring Dads) $65.00/Episode(Family Session) $150.00/Episode(Anger/Domestic Violence Evaluation) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible,but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. 14 PY-12-13-CPS-0117 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 PY-12-13-CPS-0117 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program (PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost,protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential,prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social, emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-12-13-CPS-0117 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. 'standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-12-13-CPS-0117 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 18 PY-12-13-CPS-0117 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only,should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online(if applicable to the service provided),2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement),and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-12-13-CPS-0117 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core& Service Contract Coordinator Date 20 r. 4 aft O0. 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CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND IDEA FORUM,INC. ou This Agreement,made and entered into the 6 day of 2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,o behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and Idea Forum, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS,required approval, clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Monitored Sobriety Services;and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31,2013,unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 1 ,?O4,9- a89 PY-12-13-CPS-0108 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 71h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement,CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations,including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et seq.and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CPS-0108 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin,and sex,religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees, CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended, proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. H. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CPS-0108 iv. Have not,within a three-year period preceding this Agreement,had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a) has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and (c)shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers, or agents while performing duties described in this 4 PY-12-13-CPS-0108 Agreement. CONTRACTOR shall indemnify,defend, and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement,it has currently in effect all necessary licenses,approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 • PY-12-13-CPS-0108 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. 6 PY-12-13-CPS-0108 c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Marcela Paiz President/Chief Executive Officer Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Marcela Paiz, President/Chief Executive Officer P.O. Box A 2560 West 29th Avenue Greeley,CO 80632 Denver,CO 80211 1970)352-1551 {303)477-8280 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation" includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CPS-0108 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections, paragraphs,sentences, clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of 8 PY-12-13-CPS-0108 interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal,amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven (7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection,no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CPS-0108 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets,business affairs, internal operations and management procedures and those of its customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CPS-0108 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: �/ \• '.� BOARD OF COUNTY COMMISSIONERS " \e. `$.\ WELD COUNTY,COLORADO Weld County Clerk to the Board Ism, fS- -- �I N x / Sean P.Conway,Chair . AUG 0 8 20 0 By: Deputy Clerk to a Board APPROVED AS TO FORM: �� yy County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: y A.Grieg , Director Con a. or Title 11 t9ia— 070i'' PY-12-13-CPS-0108 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide timely and quality monitored sobriety services to adult and adolescent clients, both male and female,referred by the Department,as follows: a. Services are available in Denver,Aurora, Brighton and Thornton,CO. Hours of service for all sites are Monday through Thursday,9 a.m.-9 p.m.; Friday,9 a.m.-8 p.m.;Saturday,9 a.m.-1 p.m. b. CONTRACTOR will provide qualified monitored sobriety collectors. c. CONTRACTOR is a licensed provider sensitive to multicultural issues and can provide all services in both English and Spanish. d. CONTRACTOR will confirm all positive and negative Breathalyzer monitored sobriety results within 24 hours through a phone call,test result, e-mail and/or fax to the referring caseworker. e. CONTRACTOR will confirm all positive and negative laboratory Urinalysis results will be confirmed once processing has occurred through Redwood Toxicology(usually within three days). Confirmation will occur through a phone call,test result,e-mail and/or fax to the referring caseworker. f. CONTRACTOR will report all positive and negative Instant Urinalysis results within 24 hours. If the result is positive,it will be sent to Redwood for final confirmation. Confirmation will occur through a phone call,test result,e-mail and/or fax to the referring caseworker. g. CONTRACTOR will submit a copy of the valid Authorization for Services form, result and client sign-in sheet(if applicable)with each monthly billing. h. All processed(laboratory)test results will be available online 24 hours per day,seven(7) days per week online at Redwood Toxicology(www.webtoxicologv.com). 12 PY-12-13-CPS-0108 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $8.00/Episode(Swab) $15.00/Episode(Urinalysis) $40.00/Episode(Ethyl Glucuronide-EtG) $120.00/Episode(Urinalysis-Steroids) $40.00/Episode(Urinalysis-Synthetic THC aka"Spice") $99.00/Episode(Hair Test) $6.00/Week(Breathalyzer, 1-3/Week) $10.00/Week(Breathalyzer, Daily) $50.00/Month (Antabuse without Treatment) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`"day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. 13 PY-12-13-CPS-0108 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 14 PY-12-13-CPS-0108 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers'protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-12-13-CPS-0108 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate,CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-12-13-CPS-0108 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.)are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 17 PY-12-13-CPS-0108 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date(appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only,should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online(if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3)Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley, CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CPS-0108 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core&Service Contract Coordinator Date 19 b O a 1,.. ,.,,,,, ..,, . . 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LINDSTROM, PH.D., LLC 007 a This Agreement, made and entered into the O day of4a9, 2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,o% behalf of the Weld County Department of Human Services, hereinafter referred to as the"Department"and Barry R. Lindstrom, Ph.D., LLC, hereinafter referred to as the"Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Mental Health Services;and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2012 upon proper execution of this Agreement and shall expire May 31, 2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services," of which are attached hereto and incorporated herein by reference 3, Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 aoi,-aL PY-12-13-CORE-0141 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders,and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et seq. and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-0141 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race,creed, color, se,or national origin, be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq. and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963; and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible, as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements, or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state, or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CORE-0141 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a) has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101, et. seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101,et seq.,and(c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan (PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor, or their employees, volunteers, or agents while performing duties described in this 4 PY-12-13-CORE-0141 Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease, covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals, insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0141 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0141 b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Barry R. Lindstrom Psychologist Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Barry R. Lindstrom, Ph.D. P.O. Box A 3211 20th Street, Suite D Greeley,CO 80632 Greeley, CO 80634 1970)352-1551 (970) 356-3100 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0141 19. Termination This Agreement may be terminated at any time by either party giving thirty(30) days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado,to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act 4424-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph,sentence,clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence, clause, and phrase thereof irrespective of the fact that any one or more sections,subsections, paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0141 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan,grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local,federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on-site visits, all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven(7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information. CONTRACTOR shall advise its employees, agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-12-13-CORE-0141 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs, internal operations and management procedures and those of its customers,clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0141 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS \- \ WELD COUNTY, COLORADO Weld County Clerk to the Board `,f% Sean P.Conway,Chair '` ' ,‘" AUG 0 8 201 By: Deputy Clerk t e Board APPROVED AS TO FORM: re cfrn_k_ County Attorney WELD COUNTY DEPARTMENT CONTRA OF HUMAN SERVICES By: By: J y . Griego Director ontract r r Tle 6friti 79( 41/1' 11 (D2G/o? C%7M i PY-12-13-CORE-0141 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Mental Health Services to individuals, couples and/or families referred by the Department, at 3211 20th Street, Suite D, in Greeley, CO, unless otherwise arranged.Services include the following: a. Mental Health Assessments/Psychological Evaluations—Assessments/Evaluations include an individual clinical interview to obtain relevant psychosocial history and mental status evaluation with each referred family members, conjoint clinical interviews with all family members(when applicable), conjoint clinical interview with child and current caregiver(s) if child is in out-of-home placement at the time of the referral, and psychological screening and testing. For adults,screening and testing may include the Beck Depression Inventory, Beck Anxiety Inventory, Penn Inventory for Post-Traumatic Stress Disorder(PTSD), Stressful Life Events Questionnaire, Rotter Incomplete Sentences, Mood Disorder Questionnaire,Adult Self-Report Scale(for ADHD), and other screening instruments as needed.These may include the Minnesota Multiphasic Personality Inventory-2(MMPI-2), Million Clinical Multiaxial Inventory-III (MCMI-III),Wechsler Abbreviated Scale of Intelligence(WASI), Bender Gestalt Visual Motor Test(BGVMT);Thematic Apperception Test(TAT), Projective Drawings, and the Rorschach Test. For children and adolescents,screening and testing may include the Behavioral Assessment System for Children (BASC)standardized behavioral assessment for each child, completed by the child(as age appropriate), parents,foster parents and teachers; Stressful Life Events Questionnaire; other non- standardized behavioral assessment and developmental history forms completed by parents,foster parents, and teachers as clinically indicated; Minnesota Multiphasic Personality Inventory for Adolescents(MMPI-A); Millon Adolescent or Pre-Adolescent Clinical Inventory(MACI, M-PACI); Thematic Apperception Test(TAT)or Children's Apperception Test(CAT); Projective Drawings; and the Rorschach Test. As clinically appropriate,evaluations will include consultation with collateral contacts, review of case records, previous evaluations and treatment records. b. Family(Interactional) Evaluations-Evaluate the child,the caregiver and the interaction between them across two or more sessions. Family evaluations require an average of eight(8) hours of direct contact and include the equivalent of an individual Mental Health Assessment of each family member and assessment of interaction between family members. Evaluations will assess risk factors from the Kempe Family Stress Inventory including: Parent Beaten or Deprived as a Child; Parent has a History of a Criminal Record, Mental Illness or Substance Abuse; Parent Suspected of Abuse in the Past; Parent with Isolation, Low Self Esteem or Depression; Multiple Stresses or Crises;Violent Temper Outbursts; Rigid, Unrealistic Expectations of the Child's Behavior; Harsh Punishment of Child; Child Difficult or Provocative or Perceived to be by Parent; and Child Unwanted or at Risk for Poor Bonding/Attachment Difficulties. Family Evaluations can also assess level and intensity of visitation and address issues related to visitation between children and incarcerated parents.The evaluation will include some or all of the following depending on family composition,child's placement and the caseworker's referral questions, and take from one to three months to complete: i. Interviews: a. Individual Clinical Interview(s)with each family member(1 to 2 hours for each member); b. Conjoint clinical interviews with all family members(including marital, parent-child, and sibling subsystems as clinically indicated; 3 to 5 hours) 12 PY-12-13-CORE-0141 c. Conjoint clinical interview/consultation with child and current caregivers (foster parent, relative etc)if child is in out of home placement at the time of evaluation. H. Psychological Testing: a. Adults: Millon Clinical Multiaxial Inventory-Ill (MCMI-III), Beck Depression Inventory, Beck Anxiety Inventory, Penn Inventory for PTSD,and Stressful Life Events Questionnaire(and others as clinically indicated)for each adult. [Additional psychological testing(see complete list above) can be completed as needed to address additional referral questions related to individual psychological functioning]; b. Children and Adolescents: Behavioral Assessment System for Children (BASC) standardized behavioral assessment for each child,completed by the child (as age appropriate), parents,foster parents, and teachers. Other non- standardized behavioral assessment and developmental history forms completed by parents,foster parents, and teachers as clinically indicated. iii. Evaluation Reports: A written report for all assessments/evaluations will be provided to the referring caseworker within thirty(30)days of the completion of the evaluation.This report will summarize the referral questions; brief case history;evaluation course; methods and procedures (including psychological testing, records reviewed and collateral contacts);findings; conclusions and recommendations. Evaluation reports will address both strengths and protective factors and risk factors or problems. Recommendations will focus on how to maintain the child in his current placement, or how a change in placement would help to move the child closer to his permanency goal. If the child is legally free for adoption, recommendations will include whether the goal of adoption is appropriate at that time and/or how to move toward getting the child into an adoptive home, and what type of home would best meet the child's needs. iv. Client Feedback: Individuals and families will be offered a final diagnostic feedback session as part of the evaluation process to discuss test results and the findings and recommendations of the evaluation. Copies of the evaluation will be distributed to appropriate parties by the caseworker or psychologist in keeping with privacy laws, client consent and legal and professional standards. a. Individual and Family Treatment Services—Services will be problem-focused and will assist in the resolution of the issues that led to the Department's involvement with the family, as well as supporting the treatment goals of safety,well being and maintenance of the child's placement.Treatment will include development,cognitive-behavioral and family systems approaches with an emphasis on a continuum of care and evidence-based practices. 2. Services will be provided by Barry R. Lindstrom, Ph.D., and Bonnie S. Lindstrom, M.S, LPC.All Mental Health Assessments and evaluations will only be conducted by Barry R. Lindstrom, Ph.D. 13 PY-12-13-CORE-0141 3. CONTRACTOR will make at least three(3) attempts to contact the client and set up services.The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 4. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. S. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral.Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues.Areas of concern should be reported immediately AND on the required monthly report. 6. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 7. CONTRACTOR will participate in team reviews of ongoing services as needed.These will primarily include staffings and Utilization Review Team (URT)and are not considered billable hours. 14 PY-12-13-CORE-O141 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $325.00/Hour(Evaluation) $125.00/Hour(lndivudal Therapy-Ph.D.) $65.00/Hour(Individual Therapy-M.S.) $150.00/Hour(Family Therapy-Ph.D.) $75.00/Hour(Family Therapy-M.S.) $150.00/Hour(Court Facilitation/Staffing/Case Consultation - Ph.D.) $75.00/Hour(Court Facilitation/Staffing- M.S.) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. 15 PY-12-13-CORE-0141 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 16 PY-12-13-CORE-0141 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program (PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive, social,emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 17 • PY-12-13-CORE-0141 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child, sibling/sibling,extended family/child, etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR'S service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 18 PY-12-13-CORE-0141 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 19 PY-12-13-CORE-0141 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley, CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 20 PY-12-13-CORE-0141 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core &Service Contract Coordinator Date 21 - ,- ,..--kik., O o Q �. 4--,,!. G) C) ,- M r co E `- Cr' w E ry= E _ v Q � � f; O = O N l!) N - 7 L O .Y'•� c') ti -p y �_ I ! i Qi wW � Op V1HO > 2dO M ,, 2 .. fC ' cl L � (0 N O ,_ C It f,4) 012 O D N NTO N 7 L c O mDC o < I odd -'°c" o m ?, Q N V N CC H w a) r) co O O O u) O O }�, L o +^�y�y O U) ate) 4' O N O Q �? OD al N N z o ac a� y m LLI 2cn < LJ � °' ao �� c�i U) Ill J > (1) O J O " . N N ...1 Q i CO w O < U) 0 . (13 Z Q 'O (n to J O L ^ U) LLi .. X t� zE54, u' - o z .4- Z 2Za � ' cu (.0 I co To 0 cm co oo N �' N O (0 a:'' 0 L (O 2 V) �2r (U O (n N J N to d r Q -O Em I) m a' Z.; ) (O a) F- d � ` 3U Jn o = J LU „,,- ow, re trG TCL Z Q7 N Z 0 dap Q �' E we W L O NJ Em Z ,2J O --- } gQ Oar N a) < N v. c,_ ct � a0 U � c� O - )a LE f 7 48 473 O \ \ a) a. ' 10 0.1 01 w ) / O < ! 3 ) ) f ( no { 2 H � � ul o \ tto al ( in Z ® � a cc ) \ § ; f CC ) ) VI eb | > : j \To 05 \ O3 § § / : vi f ~ ( CIS _C \ \ \ § § - - � � . f cc E } 5 ku -CO _ _ § 0 � - 45 _ \ € 0 E .2 .- % c - - ! ! ) / 01 ! ; E { } z : Tr ;C0. { : Lu _to ) i § V / e a ) _ § } FM 01 11 ` 42 T, z | \ t \ 7 0 }; % ) \ Z = \ ) ) ( }f z - I yt 'VA PY-12-13-CPS-0094 Ceti-- CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH This Agreement,made and entered into the g—day of 2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,o behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department" and North Range Behavioral Health,hereinafter referred to as the"Contractor". W ITN ESSETH WHEREAS, required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Anger Management/Domestic Violence Evaluation and Treatment Services;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 1 PY-12-13-CPS-0094 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders, and all applicable standards, regulations,interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et. seq. and its implementing regulation,45 C.F.R. Part 80 et seq.; and 2 PY-12-13-CPS-0094 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin,be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex, religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R.Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible, as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CPS-0094 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3),if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety,Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CPS-0094 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement,it has currently in effect all necessary licenses,approvals,insurance,etc.,required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CPS-0094 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CPS-0094 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Larry D. Pottorff Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Grieco, Director Larry D.Pottorff, Executive Director P.O. Box A 1300 North 17th Avenue Greeley,CO 80632 Greeley,CO 80631 1970)352-1551 (970)347-2373 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy,reorganization and/or foreclosure. 7 • PY-12-13-CPS-0094 19. Termination This Agreement may be terminated at any time by either party giving thirty (30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities,rights, benefits,protections or other provisions,of the Colorado Governmental immunity Act§524-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, director indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CPS-0094 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation,renewal,amendment,or modification of any Federal contract,loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven(7)year period, or if audit findings have not been resolved after a seven(7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection,no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-12-13-CPS-0094 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs, internal operations and management procedures and those of its customers,clients or affiliates, but does not include information (1) lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 • PY-12-13-CPS-0094 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: A 1, BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO Weld County Clerk to the Board P.Conway,Chair AUG 0 8 2 By. Cl Deputy Clerk t he Board 'x /P `,? \y APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES NORTH RANGE BEHAVIORAL HEAT TH By: By: J A.Griego, rector Contract Larry D. ttorff Executive Director Title 11 &©/&-cQd3)9 PY-12-13-CPS-0094 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Anger Management and Domestic Violence services to males and females, 18 years and older,in the Greeley area. 2. Services will be provided at the North Range Behavioral Health Adult Outpatient facility, located at 1260 H Street,in Greeley,CO. 3. All services will be provided by academically qualified and/or licensed Domestic Violence Offender Management Board(DVOMB)approved staff. 4. CONTRACTOR will provide the following services under this contract: Anger Management • Group Process and Skills (Minimum 20 Weeks of Treatment) • Cognitive-Behavioral Skills • Passive,Aggressive and Assertive Domestic Violence Behaviors (Length of treatment will comply with • Victim Empathy Domestic Violence Offender management • Treatment Goals • Substance Abuse Board(DVOMB)regulations based on • Stages of Change placement criteria for treatment levels A, B or • Parenting C.) Track(level)is determined by assessment • Men's Issues/Women's Issues(as DVOMB approved screening tools. Tracks are applicable) as follows: • Effects on Children (DV only) • Steps to Problem Solving - Track A: One(1)group session per • Steps to Conflict Resolution week. Minimum of two(2) • Characteristics of Assaultive Adults treatment plan reviews taking place • Attitudes Toward the Opposite Sex every 2-3 months,depending on • Sex Role Training progress on the required Core • Socio-cultural Basis for Violence Competencies(see below). • Provocation - Track B: One(1)group session per • Appropriate Containment and week and one(1)additional contact Expressions of Anger • Experiencing Emotions and Feelings per month. Minimum of three(3) Beyond Anger treatment plan reviews taking place • Grief and Loss every 2-3 months,depending upon • Depression and Anxiety progress on the required Core • Stress Management Competencies(see below). • Relapse/Recidivism Prevention - Track C: One(1)group session per • Healthy Relationships week and one(1)additional contact • Sexuality per week. Minimum of three(3) • Spirituality • Resources treatment plan reviews taking place every 2-3 months,depending upon progress on the required Core Competencies(see below). 12 PY-12-13-CPS-0094 Additional contacts will be in a group or individual setting depending on the clinical need. Core Competencies(per DVOMB regulations): A. Commitment to eliminate abusive behavior. B. Personal Change Plan work. Demonstrate change. C. Complete the Personal Change Plan Worksheet. D. Recognize and demonstrate empathy. E. Accept full responsibility for the offense and abusive history. F. Identify and reduce pattern of power and control behaviors, beliefs and attitudes of entitlement. G. Accountable for abusive behaviors, accept consequences,take steps to reconciliation to prevent future abusive behaviors. H. Accept that abusive behavior should have and has consequences. I. Participate and cooperate in treatment. J. Ability to define types of DV. K. Understand,identify and manage own pattern of violence. L. Understand intergenerational effects of violence. M. Understand and use healthy communication skills. N. Understand and use time outs. 0. Recognize financial responsibilities as required. P. No new violence or abusive offences. Q. Prohibited from purchasing, possessing,or using firearms and ammunition. 13 PY-12-13-CPS-0094 5. Anger Management and Domestic Violence Intakes will be completed with recommendations before the client is placed into treatment. The intake will determine the best placement for the client in regards to treatment,which may include group session and/or individual sessions. CONTRACTOR will provide a copy of the intake to the caseworker. 6. Individual sessions may be determined necessary at intake but will only be utilized under one or more of the following circumstances: • The referred client's individual treatment needs cannot be adequately addressed in a group setting. • The client is not currently appropriate for a group setting and requires a limited number of individual sessions to prepare for a group setting. • The client's job requirements make it impossible to attend regularly scheduled group sessions and individual sessions are the only option for the client to comply with their treatment plan. • When assessed for a DV track in which an additional contact is required. 7. If the client is assessed at a higher level of care than what is offered by CONTRACTOR,a recommendation to an agency that offers that level will be made. 8. CONTRACTOR will comply with the Colorado Domestic Violence Offender Management Board's Standards and Guidelines. 9. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 10. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 11. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child of a parent whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 13. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team (URT)and are not considered billable hours. 14 PY-12-13-CPS-0094 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $200.00/Episode(Anger Management or Domestic Violence Evaluation) $35.00/Episode/Per Person (Group Session) $17.50/15 Minutes(Individual Session) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 • PY-12-13-CPS-0094 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost,protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-12-13-CPS-0094 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional,educational and behavioral well-being of the child. When appropriate,CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-12-13-CPS-0094 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information,client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 18 • PY-12-13-CPS-0094 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in delay of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11`"Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 • PY-12-13-CPS-0094 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 20 ' �€ss,.n , 1st- s- — `�. ' { "s` ¢ .. � §t ',At. � t 0 * 7 re Q1/2' ,••1:',..,..k...'. `o m to N Y �ift'+"`y ; a t Ott ::,.;..c1:1-,s1::.T ' t ,f�!?! _ r U o >." to c`�o u"'i CD 1� tt y ,,, it ssF n Fk t (( r' n�, � � r .�� st r > m U m m w `o r> , � "x` :r's�`t'g` E ._ I6 moo , s '_ a : a a c — E m O N. 18 (n F U 2 d C7 .. ',„�": >. At, `a''.t T•' '4 :.d"a .C� .,w +'° - v-' :,_., 3 r„ er. N j .. N l0 v O 'C to U -o Q ri �. o am o R N El rt . U `mxra O w d « W O N L U ` O N N4..¢ Z c Z av y d H W o o a c a d U U Q W co Kahn W ; m N c CO a O.t « Ol z te!'az c Q (/) 0 to N If z o Q 'O O J LOto W yrl in • m n x 2E Z w e S Z a E °grvu%1 En co mod: Nt m m ¢#1 N rL GD rolr': C 72 W W' N N N O N tD O N N Z L ai (q N J v ED w -Lai; `m N N I— 0) D_ - - ; i) 2U Tr t O ai O E } W Ul O 0 ® — N a � .:': O v co W � wW ¢ E U O N J E C z tO J O v ¢°. U y a m e d nj ri m y Q o a a) v Q o .."- L- aO UWwo p c a- Lo o 0O kie { a) a) \ — { ci H j / 2. k } { f 2 gi C Lo 0 cu in E ) ) ro ! \ \ - E 0. \ Si \ S as c "1". . - 0 > To \ } � \ ell C ` &OS ! § ] / , al VI f 00 / al k 7 _ \ } | ( | \ Ej /4. � , en k2 § yi in / _ 1 E ) ) an - ) } — ! - 4 \ \ cc z \ } \ \ \ § t ! e . iG \ k \ \ \ \ \ \\ ) \ { } \ \ \ / j ( Z2 } k r - - .-� 6-71/56/A Q., CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH This Agreement,made and entered into the 'r c day of411(�',2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,or�behalf of the Weld County Department of Human Services, hereinafter referred to as the"Department"and North Range Behavioral Health, hereinafter referred to as the"Contractor". WITNESSETH WHEREAS,required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Functional Family Therapy(FFT);and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 PY-12-13-CORE-0120 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5, Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms,or reporting requirements. In the event of forfeiture of reimbursement,CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et. seq. and its implementing regulation,45 C.F.R. Part 80 et seq.; and 2 PY-12-13-CORE-0120 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin,be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963; and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex,religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R.Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. H. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-12-13-CORE-0120 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3),if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-763-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law,(b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety,Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0120 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals,insurance,etc.,required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0120 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-12-13-CORE-0120 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Larry D. Pottorff Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Larry D.Pottorff, Executive Director P.O. Box A 1300 North 17th Avenue Greeley,CO 80632 Greeley,CO 80631 1970)352-1551 1970)347-2373 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0120 19. Termination This Agreement may be terminated at any time by either party giving thirty (30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities,rights, benefits,protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections, paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition.During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0120 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation,renewal,amendment,or modification of any Federal contract,loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven (7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-12-13-CORE-0120 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those of its customers,clients or affiliates,but does not include information(1) lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0120 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. r'r a `� ATTEST: :, r. .," > \ BOARD OF COUNTY COMMISSIONERS A WELD COUNTY,COLORADO ICP Weld County Clerk to the Board 1861 1 � r°� ° t�7 Sean P.Conway,Chair bra By: :- / AUG 0 8 2012 Deputy Clerk the Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES NORTH RANGE BEHAVIORAL HEAT By: By: J d 4, rectoQVf ontractor Larry D. P torff Executive Director Title 11 020/07— O?OC PY-12-13-CORE-0120 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provided Functional Family Therapy(FFT)services to male and female youth within the approximate age range of 11-17 years of age,and their families, residing in Weld County,as referred by the Department. 2. CONTRACTOR has offices in both Greeley and Fort Lupton,CO. 3. CONTRACTOR will provided services in accordance with the National Functional Family Therapy(FFT) model,and its standards and guidelines. All services are overseen/supervised by a FFT National Consultant. 4. FFT utilizes Family Interventions,Cognitive Behavioral Therapy,Family Therapy,school and community interventions,and substance abuse intervention,as clinically appropriate. 5. The goal of services is to: a. Empower families with the skills and resources need to independently address the difficulties they are having raising their children. b. Empower youth to cope with family, peer,school and neighborhood problems. c. Build community and natural support systems. d. Decrease negativity and blame among family members. e. Decrease anti-social behavior to include legal contacts,truancy and substance abuse issues 6. Service duration is two(2)to six(6)months for one(1)to two(2) hours per week. 7. Services include: a. Case Management b. School Interventions c. Advocacy d. Court/Staffing Participation e. Sustainability Planning f. Booster Services After Discharge 8. CONTRACTOR has the ability to provide bilingual services(Spanish). 9. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 10. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 11. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12 • PY-12-13-CORE-0120 13. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0120 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $675.00/Month (Functional Family Therapy) (Pro-rated for any partial month of service.) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 14 PY-12-13-CORE-0120 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program (PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost,protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-12-13-CORE-0120 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. 'standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-12-13-CORE-0120 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information,client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.)are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 17 PY-12-13-CORE-0120 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in delay of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents(Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CORE-0120 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAMAAAAAAAAAAAAAAAAAAAAMAAAAAAAAMMMAAAAAAAMMAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core&Service Contract Coordinator Date 19 x7.)+. it "' rI I d:7.11 "k£i . °d L i it r I r u o ' I{ r ! IL 'II 1 ; �% Z c t rn . ' .i=52Pfk e ...rf f: i _ ff I �1 s Tr p o m x ~ +w �� .«.. P i r ; `. 4 !E ;II ,!I `.if a'f c Z m ' .. _. ( t r i al W Q _ , t ''44'' i.us ..L 41741" L...,, :.lwa., !L_...»1..�.9 1 av orN r` -sue g [ s F r- r :1 p O p v O b m '-....:-*it, �, [LA 1 ye f ar ci, 71 i 'g, :S ') '�"J !'! 'J� f 1; Ti "`�'�t ` sS. o d p m a aaD , N r ^+,,�d! t; C . .`.,;,,,:iii...-.:91;...../4 J k G ' `�� ! ] ;I .i¢ j .s« a) 5 W co alo7 _ TO N 'E U V �w':s' O aj Y:.. 0 < I• `ocQ0_ , N CC al a . ₹ m al ZO `o p O co ^c. .c U o p N :. Z C Z O.-0 N N : otu w lIllIllIllIlli .ft$3 m a> ar0 yo o ?:;:l. .1,0 J aW m dv w` to o rn p < WO nr`'is0 Q v to J O . t w t N .s:'.. W m z° z' a ,_ w = m r o CC d d m ...:;. 0 g w co F;zy:zw 2 LL m o, (n• al Q _ y -o ED a m `v U CD U w I- a NO N J < J x,, E x �O at 6- T Z 2 .d al Z ' U CO � < w E we e. Ca IL -C a ° -• Uma 2cc Zma ' ) w Q o a m a) Q o L CC � a0 U coo a E U � 7 E } . \ \ \ \ r. \ \ j j ( } } { - ( � > = E el In E ) k Ea. � 2 — ` 0. - | = \ \ } E 2 cu 40 } & § La§ § / _ { N � �H col } \ _ \ \ \ u ) _ . : ! ! to § \ I- , � / 2 § i o. ) ) 0.1 — 1 } k La \ § \ ) } ) Q § \ f 01 2 § t \ k \ \ \ \ 43 II- \\ k \ } ; ; \ z \ \ H } \ 1 PY-12-13-CORE-0142 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL� HEALTH This Agreement,made and entered into the J -day of)91tt3/3 2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,.QII'behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and North Range Behavioral Health, hereinafter referred to as the"Contractor". WITNESSETH WHEREAS, required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Mental Health Services(Evaluation);and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 (9C/C,— 072)8; PY-12-13-CORE-0142 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et. seq.and its implementing regulation, 45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-0142 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin,be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R.Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986,P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex, religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R.Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal background record checks for all employees, CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CORE-0142 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas,unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0142 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0142 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-12-13-CORE-0142 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Larry D. Pottorff Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Larry D.Pottorff, Executive Director P.O. Box A 1300 North 17th Avenue Greeley, CO 80632 Greeley, CO 80631 (970)352-1551 1970)347-2373 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term "litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0142 19. Termination This Agreement may be terminated at any time by either party giving thirty (30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0142 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation,renewal,amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven (7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-12-13-CORE-0142 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets,business affairs, internal operations and management procedures and those of its customers,clients or affiliates,but does not include information (1) lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County,nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0142 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. flY-\ ATTEST: ' c s% \ BOARD OF COUNTY COMMISSIONERS �' \ WELD COUNTY,COLORADO Weld County Clerk to the Board \1/4 \'„r` / d Sean P.Conway,Chair fi By: y - AUG 0 8 2012 Deputy Clerk to e Board APPROVED AS TO FORM: _ it% CjL County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES NORTH RANGE BEHAVIORAL 1W-ATTH By: By: J y .Griegp, irector Contra r Larry D ottorff Executive Director Title 11 c,2D/a7- &Di • PY-12-13-CORE-0142 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR is the community mental health center serving Weld County. 2. CONTRACTOR will provide the following services under this contract: a. Level 1—Behavioral Health Evaluation: Useful for ruling in/out basic mental health and substance abuse issues,advising on provisional diagnoses,and making recommendations for treatment when appropriate. - Review of Department records,and if applicable, NRBH records. - Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). - Possible administration of brief screening inventories(e.g., Beck Inventories,State-Trait Inventories, Personality Assessment Screener). - Feedback to client. - Written report addressing relevant psychosocial history,diagnostic formulation,and treatment recommendations. b. Level 2- Partial Psychological Evaluation: Useful for ruling in/out mental health,substance abuse,cognitive,and/or personality issues,advising on diagnoses,and making treatment recommendations. - Review of Department records,and if applicable, NRBH records. - Clinical interview and integrated diagnostic evaluation(assessment of mental health and substance abuse issues). - Administration of a partial test battery,such as administration of just cognitive or just personality testing(e.g.,Wechsler IQ tests, MMPI, MCMI, PAI,etc.). - Consultation with collateral sources. - Feedback to client. - Written report addressing relevant psychosocial history,diagnostic formulation,and treatment recommendations. c. Level 3—Full Psychological Evaluation: Useful in identifying more significant behavioral health issues and diagnoses,as well as addressing personality issues,intellectual functioning,the ability to manage emotions,parenting issues and potential safety of the children in the home, placement issues,and treatment recommendations. - Review of all available records including Department records, prior evaluation and behavioral health treatment records,police records, medical records, records from other agencies involved in the case, and if applicable, NRBH records. - Extensive integrated clinical evaluation (multiple sessions). - Administration of a formal battery of tests(multiple tests)to assess personality,emotional and/or cognitive functioning, and/or parenting issues(e.g.,Wechsler IQ tests, MMPI,MCMI,PAI, STAXI,STAI,Beck screens,TSI, PSI, etc.). - Consultation with collateral sources. - Feedback to client. - Written report addressing psychosocial history, personality issues,emotional functioning and regulation abilities,and/or intellectual functioning and/or parenting/family issues,substance abuse,and diagnostic formulation,as well as treatment recommendations and prognosis. 12 PY-12-13-CORE-0142 d. Level 4—Extended Psychological Evaluation: Useful in identifying more significant mental health and substance abuse issues and diagnoses,as well as addressing personality issues, intellectual functioning,the ability to manage emotions,parenting issues and potential safety of the child(ren)in the home,placement issues,and treatment recommendations. To be utilized when impairment in cognitive functioning is suspected/known,when the client is unable to read or write,when there are major memory deficits,when resistance leads to invalid measures and instruments need to be re-administered,and/or when other significant barriers to testing are present. - Review of all available records including Department records, prior evaluation and behavioral health treatment records,police records, medical records,records from other agencies involved in the case, and if applicable, NRBH records. - Extensive integrated clinical evaluation (multiple sessions). - Administration of a formal battery of tests(multiple tests)to assess personality,emotional and/or cognitive functioning, and/or parenting issues(e.g., Wechsler IQ tests, MMPI,MCMI, PAI, STAXI,STAI, Beck screens,TSI, PSI,etc.). - Consultation with collateral sources. - Feedback to client. - Written report addressing psychosocial history,personality issues,emotional functioning and regulation abilities,and/or intellectual functioning and/or parenting/family issues,substance abuse,and diagnostic formulation,as well as treatment recommendations and prognosis. 3. For partially completed evaluations,CONTRACTOR will submit a written report of any finding that can be appropriately offered based upon the information gathered. 4. Evaluations will be conducted at an NRBH location or another suitable location (e.g.,client's home, school,detention center,etc.),depending upon the circumstances. 5. Evaluations will be conducted by a qualified NRBH provider. 6. CONTRACTOR will submit the written report,following completion of the evaluation,within forty-five(45) days from the point of initial contact with the client. 7. CONTRACTOR will communicate with the referring caseworker and the Core and Contracted Services Coordinator regarding any issues contacting the client,missed appointments,or other issues that arise that prevent the completion of the referred evaluation. 8. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to,any physical, emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 13 • PY-12-13-CORE-0142 11. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 14 PY-12-13-CORE-0142 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $250.00/Episode(Level 1- Behavioral Health Evaluation) $800.00/Episode(Level 2- Partial Psychological Evaluation) $1,200.00/Episode (Level 3-Full Psychological Evaluation) $1,800.00/Episode(Level 4-Extended Psychological Evaluation) $120.00/Hour(Hourly rate for partially completed evaluations. Not to exceed the cost of the full evaluation.) $120.00/Hour(Court Staffing/Facilitation) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. 15 PY-12-13-CORE-0142 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 16 PY-12-13-CORE-0142 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas,* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers'protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 17 PY-12-13-CORE-0142 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. • 18 PY-12-13-CORE-0142 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services(visitation,therapy, home-based,etc.)are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 19 PY-12-13-CORE-0142 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7`h of the month following the month of service in order to be processed for payment that month. Billing received after the 7`h of the month may result in delay of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 20 PY-12-13-CORE-0142 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAMAAAAAAAAAAAAAAMMAMAAAAAAAAAMA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 21 • N i"L. jy c r mu ----T.771. 9 ---'.1... 1,..1.. r gtk �* r° x x xxe y m n Q N v _.._.._aL 5 to N - s w i. �t i t. i U `oo �2 ≤nmu�i tt°O I. - °" ; a c .. Y r) g rt{ r ,. ��k ii.t.-• C tJ t i 4 . Y IS. o co a) 4 cog")) , .fig :; ; ;~ s t it ., (f) l— U �i2d (7rn w is "-• N N O O C ct a2 O = N d '' t0 y -C ' O _ > > 0 0 . a' a O O W O Qx ova U • a y 0 'V N r c.„, a . O ` to Z _ N t`O CD ❑ `O W o O O e L O O 00 5- N u. LE 2 c ¢ wa v c° m Lu -O N l)) g'.!i'i o.a ca w Co Z : C ,:...c.�ls. J OL. U y a m LO N Z N = Z a N d3 w = t0 To 0 co c U O N co in C0WIL co N J = N d -o E D N .,--a] d a: tug w a 'Ha) gel CUOQ 9 X fa w O N J W a U O )`a' Z 112 « U) Z U Q to w c t.,..:u oW m ,-..Wt .m-I O NJ Em Z To J O U O a m e a ti -o Q2 2 0 v w C to tU Q o n .- N Q O } tau) aO Ua (oo a 3 ) ) t | AI an \ ) N. - { E Tv j { \ IJ 2 « ! | { ; 76 | / \ \ � . \ \ } \ty } cc� \ \ } 48 .t FL� \ E. & . § rn § \ a) , f oi22 } — a. — § § { =12 E E } , ea k / r ` / 2 § § ) } _ | ( ( y. \ Ew } - | { — _ | } \ li 11 \ \ \ \ \ rtti ; { to 2 8 _ � ` ) L t - 8 a a § k \ / \ \ \ �\ 76 k { } ) \ \ / ) o \/ ) | PY-12-13-CPS-0109 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE �BEHAVIORAL �HEALTH This Agreement, made and entered into the e d ay of /27 2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,o behalf of the Weld County Department of Human Services, hereinafter referred to as the"Department"and North Range Behavioral Health,hereinafter referred to as the"Contractor". WITN ESSETH WHEREAS, required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Monitored Sobriety Services;and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012, upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 1 PY-12-13-CPS-0109 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CPS-0109 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin,be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R.Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R.Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex, religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R.Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records,making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PV-12-13-CPS-0109 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a) has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law,(b)shall produce one of the forms of identification required by C.R.S. 24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas,unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CPS-0109 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals,insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CPS-0109 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-12-13-CPS-0109 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Larry D. Pottorff Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Larry D. Pottorff, Executive Director P.O. Box A 1300 North 17th Avenue Greeley, CO 80632 Greeley,CO 80631 (970)352-1551 J970)347-2373 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy,reorganization and/or foreclosure. 7 PY-12-13-CPS-0109 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities,rights, benefits,protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer,member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CP5-0109 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation, renewal,amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven(7)year period, or if audit findings have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection,no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CPS-0109 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those of its customers,clients or affiliates, but does not include information (1)lawfully obtained from third parties, (2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CPS-0109 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: ,- , BOARD OF COUNTY COMMISSIONERS 7-$ '4.4i ELD COUNTY,COLORADO Weld County Clerk to the Board 13 „I r ?% j can P.Conway,Chair By: \�. AUG 0 8 2012 Deputy Clerk to a Board APPROVED AS TO FORM: Cry County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES NORTH RANGE BEHAVIORAL HEALTH By: d, By: J d A.Grie o, irector Contrac Larry D. ttorff Executive Director Title 11 doic -a12� PY-12-13-CPS-0109 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: a. Services will be provided at the North Range Behavioral Health Crisis Stabilization Services facility in Greeley,CO,at 1140 M Street,or in Fort Lupton,CO,at 145 1"Street. b. CONTRACTOR will provide a qualified monitored sobriety collector 24 hours a day/seven (7) days a week at the Greeley site. At the Fort Lupton site,the CONTRACTOR will provide a qualified monitored sobriety collector Monday thru Thursday,10:00 a.m.-5:00 p.m.for Urinalysis Testing and 10:00 a.m.-7:00 p.m.for Breathalyzer Testing. On Fridays,Urinalysis Testing will be available 10:00 a.m.-12 p.m.and Breathalyzer Testing will be available 10:00 a.m.-5:00 p.m. Services are not available in Fort Lupton on Saturdays and Sundays. c. CONTRACTOR will confirm all positive and negative Breathalyzer monitored sobriety results within 24 hours through a phone call,test result,e-mail and/or fax to the referring caseworker. d. CONTRACTOR will confirm all positive and negative laboratory Urinalysis results will be confirmed once processing has occurred through Redwood Toxicology(usually within three days). Confirmation will occur through a phone call,test result,e-mail and/or fax to the referring caseworker. e. CONTRACTOR will report all positive and negative Instant Urinalysis results within 24 hours. If the result is positive,it will be sent to Redwood for final confirmation. Confirmation will occur through a phone call,test result,e-mail and/or fax to the referring caseworker. f. CONTRACTOR will submit a copy of the valid Authorization for Services form,result and client sign-in sheet(if applicable)with each monthly billing. g. All processed(laboratory)test results will be available online 24 hours per day,seven (7) days per week online at Redwood Toxicology(www.webtoxicology.com). 12 PY-12-13-CPS-0109 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2,below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $20.00/Episode(Urinalysis-5 Panel: THC,Cocaine,Amphetamines, Benzodiazepines,Opiates) $20.00/Episode(Urinalysis-7 Panel: THC,Cocaine,Amphetamines, Benzodiazepines,Opiates, Barbiturates,Alcohol) $20.00/Episode(InstaCheck 5 Panel) $20.00/Episode(Multi-Panel Instant Urinalysis) $20.00/Episode(Instant Swab) $35.00/Episode(GCMS-Confirmation of Positive Result) $5.00/Episode(Breathalyzer) $100.00/Episode(Hair Test) $50.00/Episode(Patch) $30.00/Episode(Ethyl Glucuronide Test aka EtG) $50.00/Episode(Urinalysis-Expanded Designer Stimulants-14 Panel) $35.00/Episode(Urinalysis-MDPV, Mephedrone, Methylone-3 Panel) $35.00/Episode(Urinalysis-Synthetic Cannabinoids-"Spice") $35.00/Episode(Oral Swab-Synthetic Cannabinoids-"Spice") CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible,but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 13 PY-12-13-CPS-0109 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 14 • PY-12-13-CPS-0109 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-12-13-CPS-0109 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-12-13-CPS-0109 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information,client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 17 PY-12-13-CPS-0109 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in delay of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CPS-0109 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core&Service Contract Coordinator Date 19 gil,, �' 'ye .�i..S# St eF iw", "„;a, '.', mp "art 8 O y N ,co try t "n x k4 i Yt k {,1, x 2" 2 co = N .0- ,4a &Y s ' i. •• ••/S ' .Y n° f r' yY .: 5 Lei C d rn Q Nco Cv »'T'_':tih U O ON1mu�im , eE 14"t? n iF ., rN4'R' " o °1U may .— r § F-.41y r a:. i, -Y i 77,11r:':',1 . 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I- u 01 C a, pi 7 § _ 2 . - § ( ) } , k j / Z iii \ / § q cc % i f_ \ . k t . , 2 LeJ § > } ' t 0 co 5 w a. a. E ' Cl ( C 3 o 'eae Q f v § \ j % _ / § § E E ) ) ) f = 2 E - a % o. § ) / 515 ) / § $ k a } Z . a } f - = j �. \ . . t- © 'I-- u k i f § - k \ 0 C \ k \ a E R ) k 5 \ • \ .553 k m 2 \ 02' E \ 03 $ < 7 = t � 2k CL ■ 0 . - o) - = \ \ E - � —12 O'0 §ZZ 27 = } \ - � g § a � � 0. # k k » \ § }/ I # f /J PY-12-13-CORE-0146 ��" �� r CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH Sd This Agreement, made and entered into the day of 2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,o behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and North Range Behavioral Health,hereinafter referred to as the"Contractor". WITNESSETH WHEREAS,required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Multisystemic Therapy(MST);and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1.2012, upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 O/, — &CY 5 PY-12-13-CORE-0146 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. S. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et. seq.and its implementing regulation, 45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-0146 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin,be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986,P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex,religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R.Part 2. 45 C.F.R.Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal background record checks for all employees, CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CORE-0146 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3),if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law,(b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety,Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas,unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0146 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals,insurance,etc.,required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0146 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-12-13-CORE-0146 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Larry D. Pottorff Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Larry D. Pottorff, Executive Director P.O.Box A 1300 North 17th Avenue Greeley, CO 80632 Greeley,CO 80631 f970)352-1551 f970)347-2373 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation" includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0146 19. Termination This Agreement may be terminated at any time by either party giving thirty (30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities,rights, benefits,protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer,member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition.During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0146 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation,renewal,amendment,or modification of any Federal contract,loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal, and state auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven(7)year period, or if audit findings have not been resolved after a seven (7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection,no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-12-13-CORE-0146 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets,business affairs,internal operations and management procedures and those of its customers,clients or affiliates,but does not include information (1) lawfully obtained from third parties, (2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0146 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: - BOARD OF COUNTY COMMISSIONERS r' _ WELD COUNTY, COLORADO a �rd 4, a' Weld County Clerk to the Board V8fi' � j .' -+ Sean P.Conway,Chair r AUG 08 2012 By: Deputy Clerk to a Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES NORTH RANGE BEHAVIORAL HEALTH By: By: d S$rectoQt Executive Director Title 11 cA7D/a2-07x5 • PY-12-13-CORE-0146 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provided Multisystemic Therapy services to male and female youth within the approximate age range of 12-17 years of age,and their families,residing in Weld County,as referred by the Department. 2. CONTRACTOR has offices in both Greeley and Fort Lupton,CO. 3. CONTRACTOR will provided services in accordance with the National Multisystemic Therapy(MST)model, and its standards and guidelines. All services are overseen/supervised by a MST National Consultant. 4. MST utilizes In-home Caregiver Interventions,Cognitive Behavioral Therapy,Family Therapy,Individual Therapy,as well as school and community interventions. 5. The goal of services is to: a. Empower caregivers with the skills and resources needed to independently address the difficulties related to managing their children. b. Empower youth to cope with family,peer,school and neighborhood problems. c. Build community and natural support systems. d. Decrease anti-social behavior. 6. Service duration is two(2)to five(5)months for three(3)to five(5)hours per week. 7. Services include: a. 24/7 On-call Services b. Case Management c. School Interventions d. Advocacy e. Court/Staffing Participation f. Sustainability Planning 8. CONTRACTOR has the ability to provide bilingual services(Spanish). 9. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 10. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 11. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to,any physical, emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12 PY-12-13-CORE-0146 13. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-O146 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $1,800.00/Month (Multisystemic Therapy) (Pro-rated for any partial month of service.) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in delay of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 14 PY-12-13-CORE-0146 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost,protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers'protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-12-13-CORE-0146 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Departments CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-12-13-CORE-0146 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy),each member should sign the same form at the time of service. 17 PY-12-13-CORE-0146 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7`h of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in delay of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11`h Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CORE-0146 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAMMA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core&Service Contract Coordinator Date 19 a� r [ C '.O.. 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I I} z ) PY-12-13-CORE-0219 / CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SAVIO HOUSE' This Agreement, made and entered into the D -ay ofd, 2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,on/behalf of the Weld County Department of Human Services, hereinafter referred to as the"Department"and Savio House, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Foster Parent Consultation; and NOW THEREFORE,in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2012 upon proper execution of this Agreement and shall expire May 31, 2013, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D"Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 o? O/ —a?t PY-12-13-CORE-0219 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement,CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et. seq.,and its implementing regulation,45 C.F.R. Part 80 et. seq.;and 2 PY-12-13-CORE-0219 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race, creed, color,se,or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations,45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et. seq. and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.5.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain,or performing a public (federal, state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state, or local)with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-12-13-CORE-0219 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state, and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et.seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas,unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor,or their employees,volunteers, or agents while performing duties described in this 4 PY-12-13-CORE-0219 Agreement. CONTRACTOR shall indemnify,defend, and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR,shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense, and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement,it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0219 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data, special analyses, on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0219 b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: William S. Hildenbrand Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director William S. Hildenbrand, Executive Director P.O. Box A 325 King Street Greeley, CO 80632 Denver,CO 80219 {970) 352-1551 (303) 225-4014 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0219 19. Termination This Agreement may be terminated at any time by either party giving thirty(30) days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph, sentence, clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer,member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0219 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation,renewal, amendment,or modification of any Federal contract, loan,grant, or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits, all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven (7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information. CONTRACTOR shall advise its employees, agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CORE-0219 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs, internal operations and management procedures and those of its customers,clients or affiliates, but does not include information(1) lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0219 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS . WELD COUNTY,COLORADO • 1161: p Weld County Clerk to the Board ( - Sean P. Conway,Chair ` / AUG 0 8 2012 By: Deputy Clerk the Board APPROVED AS TO FORM: Cif County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: G�l/Y!''��G�l�✓[ J A.Gri g Director Contractor Title 11 a oia -aA PY-12-13-CORE-0219 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide consultation for children and youth residing in Weld County foster homes, as referred by the Department. The goal of the program is to enhance and improve the quality of care being provided to Weld County's children and youth. 2. CONTRACTOR will provide services face-to-face in the foster home of the referred child or youth. 3. CONTRACTOR has staff proficient in Spanish and American Sign Language. 4. CONTRACTOR will work collaboratively with children,foster parents, caseworkers,foster care coordinators and other service providers to identify and address issues,in a solution-focused manner, which could potentially disrupt placements. 5. CONTRACTOR will make recommendations to foster family following assessment of the child. CONTRACTOR will document recommendations and follow through of foster family with regard to recommendations. 6. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care for the foster children in their home and report this information on a monthly basis to the Department. 7. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 8. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to,any physical, emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 10. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 11. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 12 PY-12-13-CORE-0219 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $56.00/Hour(Foster Parent Consultation, Face-to-Face) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 13 PY-12-13-CORE-0219 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program (PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 14 PY-12-13-CORE-0219 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling, extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 15 PY-12-13-CORE-0219 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 16 PY-12-13-CORE-0219 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith, foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11`h Avenue, Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 17 • PY-12-13-CORE-0219 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. 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N> COm 01 a CO a C F a s o A c c O c a 7 Y1 '' _ • U TA m [ Sc av I- o o a u LieF E E. y Y `o > Z 4E; o o. O L C . N C 3 0t = a o OE c aj _ ` E u ° rai; cu o LL t O c o E ° > E v S nSi cu E E w m = In t Z C a 0 q c L• W K > 9 °° u 0 C _ 3 = a t V O V C a 0 2 (y m O ~ in C > y z a O a N " U C g ° O V qY i fl 0 E c o .L. v z • m a n > a a 2 w 5 m y v a � V a a .a. m a r ¢ . m r41 a CC 0 O a E E ° '° 0 A K G a O a i } '15.0 Q S a ,O a .. p, N O z n Q - E ° V v Y ZF en u E ~ _v z V 9 N O L "I o _ U O z .a. ° .°. e .N-1 u "' o a- H O u , 1 E Y o u E ° e a o ii 0 2 t. a z to a i .C...C 4p PY-12-13-CORE-0150 1817 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN ✓Ul 3/ THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES /, AND SAVIO HOUSE / aa This Agreement, made and entered into the ay of %Ke?9 2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and Savio House,hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval,clearance, and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Home Based Intensive Services;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 020/07— dDd' PY-12-13-CORE-0150 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations,including,but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et.seq.and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-0150 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin, and sex,religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records,making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CORE-0150 iv. Have not,within a three-year period preceding this Agreement,had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan (PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas,unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0150 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals,insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0150 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0150 b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: William S. Hildenbrand Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director William S. Hildenbrand,Executive Director P.O. Box A 325 King Street Greeley,CO 80632 Denver,CO 80219 1970)352-1551 1303)225-4014 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0150 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities,rights,benefits,protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0150 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation,renewal,amendment,or modification of any Federal contract,loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall, during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period,or if audit findings have not been resolved after a seven(7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CORE-0150 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those of its customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0150 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: 'NN \ BOARD OF COUNTY COMMISSIONERS • °`" N\WELD COUNTY,COLORADO Weld County Clerk to the Board 1861E k_7-,{ , fa can P.Conway,Chair By: AUG 0 8 2012 Deputy Clerk to YF a Board --i-� APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES I` /://4//t10‘ � / / ,/�// By: ` By: /:f//�J//t10 " Jud .Griego, irector Contractor LiZ�G�� Title 11 aria-aOI PY-12-13-CORE-0150 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide comprehensive programming,through their Community Based Services program,to youth,ages 12 to 20,who are referred by the Department,are in need of transitional services or family preservation services in order to prevent recidivism or placement,and prepare the youth for a pro-social lifestyle. a. Services include the following: i. Skill Building for Youth—CONTRACTOR will provide individual counseling to the referred youth as a means of maintaining the therapeutic relationship and teaching/modeling pro- social attitudes and values. Skills will be demonstrated to the youth and the youth will be given the opportunity to practice/role play new skills. All counseling sessions will incorporate the principles of Cognitive Behavioral Therapy and Aggression Replacement Therapy to address issues pertinent to the emancipating youth. ii. Budgeting and Managing Money—CONTRACTOR will teach youth to establish and maintain a workable budget and pay bills in a timely manner. CONTRACTOR will accompany youth to a local bank to establish banking services/accounts and will work with the youth to monitor expenditures and adjust the budget as needed. Youth who have outstanding restitution, the CONTRACTOR will ensure a portion of each paycheck is designated towards the youth's legal obligations. iii. Educational Support—CONTRACTOR will evaluate the referred youth's education needs and interests through a review of educational services and plans,discussions and past records during the pre-placement interview to determine what services are required. If the youth is not enrolled in an educational program,CONTRACTOR will assist the youth in identifying and enrolling in an educational/vocational program. iv. Employment and Vocational Support—CONTRACTOR,in collaboration with the referred youth and the caseworker,will determine employment interests,aptitudes and special training completed. CONTRACTOR will assist the youth in finding employment,completing applications,developing a resume and interviewing. Transportation services are available to assist the client in accessing resources,applying for jobs,attending interviews,and completing appropriate follow up. The youth also will be taught job maintenance skills. Identified caretakers will be taught to monitor all aspects of the youth's employment including hours worked,attitude,performance and income. v. Finding and Securing Housing—CONTRACTOR will work with the referred youth to find housing in an area that is appropriate for the youth. Transportation is available to assist youth in completing the necessary processes to secure housing. CONTRACTOR will ensure that the youth understands the application process,lease information,deposit requirement,rental agreement,and setting up utilities/services,as well as other associated factors such as moving,furnishing a home,and household budgeting/money management. vi. Community Resources—CONTRACTOR will work with the referred youth to identify needs and interests and will assist the youth in accessing appropriate community resources. This will include completing a checklist that identifies the location of the nearest bank,grocery store,post office and other neighborhood agencies. CONTRACTOR also will work with the youth to identify appropriate social supports that will continue to be a part of the youth's life in the future. 12 PY-12-13-CORE-0150 vii. Leisure Time—CONTRACTOR will work with the referred youth to identify the youth's recreational and social interests and assist the youth in accessing positive,age-appropriate community activities that address those interests. viii. Parenting Skills for Teen Parents—As applicable,CONTRACTOR will provide the referred teen parent,or pregnant teen,with parenting skills training and support. CONTRACTOR will determine the needs of the teen or expectant parent and address relevant topics and ensure basic parenting skills are learned. Topics may include,but are not limited to, newborn/infant/toddler development milestones,basic needs of children,age-appropriate expectations,effective communication and decision-making,positive discipline strategies and how to provide a nurturing,safe and consistent environment. The teen also may be referred to a parenting support and education group. ix. Crisis Intervention—CONTRACTOR will provide emergency response services 24 hours a day/7 days a week to assist referred youth and families in crisis. Crisis intervention may be provided by phone or through face-to-face contact dependent upon the nature of the crisis and level of intervention needed. b. Length of stay is usually four(4)to six(6)months based on the needs of the client. c. CONTRACTOR does not currently have bilingual staff. 2. CONTRACTOR will provide family preservation or reunification services,through their Community Based Services-Child Protection Division,to families with children age birth to 12 years,as referred by the Department,and who are in need of transitional services or family preservation services in order to prevent recidivism or placement. a. Services will include: i. Team Decision Making(TDM)—Family Group Conferences that involve extended family and kin. ii. Treatment Support Meetings—Family-centered,strength-based monthly staffing process to include parents,extended family,CONTRACTOR,Department staff,GAL,and other involved professionals.The process is anchored in the Colorado Assessment Continuum and the focus is on protective concerns that need to be resolved to eliminate the need for Department involvement. A work plan is established with the team outlining specific goals to be accomplished,action steps,strengths,and time frames for completion. Hi. Therapeutic Supervised Visitation—CONTRACTOR will supervise visitation and work directly with parents to improve parenting skills,eliminate safety concerns and reduce the time the child is in out-of-home placement. iv. Parenting Skills Development—Referred families will receive both group and individual instruction with an emphasis on alternatives to physical discipline,household management, consistent delivery of rules,consequences and rewards;and knowledge of developmental milestones and nutrition. b. Goals and Objectives: i. Prevent child abuse and neglect by teaching parenting skills,eliminating safety concerns and reducing risk factors; H. Strengthen families so they may remain intact; iii. Strengthen the family unit with in-home,family dictated services. 13 PY-12-13-CORE-0150 c. It is the goal of services that upon completion,referred families will possess the skills necessary to: Maintain their children in their home; ii. Eliminate the need for Department or agency involvement; No longer abuse or neglect their children;and iv. Improve the overall family functioning. d. CONTRACTOR will provide 24-hour crisis intervention services to referred families. e. CONTRACTOR has staff proficient in Spanish and American Sign Language. 3. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 4. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 5. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 6. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 7. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 14 PY-12-13-CORE-0150 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $1,600.00/Month(Child Protection. Pro-rated for any partial month of service.) $1,814.00/Month(Adolescents. Pro-rated for any partial month of service.) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible,but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 PY-12-13-CORE-0150 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential,prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-12-13-CORE-0150 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-12-13-CORE-0150 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based,etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 18 PY-12-13-CORE-0150 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date(appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months,and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online(if applicable to the service provided), 2)the billing documents(Authorization for Contractual Services with original signature and Request for Reimbursement), and 3)Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O.Box A,Greeley,CO 80632 Physical Address: 315 A North 11`h Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-12-13-CORE-0150 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. 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U d o § 2 a -o f a v 7 ' , $ ) \ OE \ \ \ - a) 0 } z '- a § R / - E } § $ 2 a ■ 0- ■ \ & 2 22 ! ■ 5 PY-12-13-CORE-0211 1p r CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN.),, THE WELD COUNTY A DEPARTMENT HOUSE HUMAN SERVICES 4 ✓P AND SA 2/ A p /, 0J7 This Agreement, made and entered into the 6 --clay of% , 2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Services, oh behalf of the Weld County Department of Human Services, hereinafter referred to as the"Department"and Savio House, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Life Skills;and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2012 upon proper execution of this Agreement and shall expire May 31, 2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 acia-aa6N, PY-12-13-CORE-0211 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders,and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et. seq. and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-0211 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations,45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended,cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.) 26-6-104, requiring criminal background record checks for all employees,CONTRACTORS, and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain, or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal, state, or local)with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-12-13-CORE-0211 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal, state, and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and (b)otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq.,and (c)shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan (PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor, or their employees,volunteers, or agents while performing duties described in this 4 PY-12-13-CORE-0211 Agreement. CONTRACTOR shall indemnify,defend, and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals, insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0211 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on-site checking,formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0211 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: William S. Hildenbrand Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director William S. Hildenbrand, Executive Director P.O. Box A 325 King Street Greeley,CO 80632 Denver,CO 80219 (970)352-1551 (303)225-4014 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term "litigation"includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0211 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado,to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause, and phrase thereof irrespective of the fact that any one or more sections,subsections, paragraphs,sentences, clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0211 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal,amendment,or modification of any Federal contract, loan,grant, or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on-site visits, all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period,or if audit findings have not been resolved after a seven (7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees, agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-12-13-CORE-0211 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2)that which is in the public domain, or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-O211 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: �� '4WaDCOUNTYWO .BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Board rat: � 'i CI S 4 Sean P.Conway, Chair , ti`s"z' • AUG 082012 By. Deputy Clerk the Board 1 �f APPROVED AS TO FORM: Z 5 (97(t, k County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES /61/1414----- J By: By: —\ y . Griggo Directo Contractor let , pat/ Title 11 ry • PY-12-13-CORE-0211 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide lower level Life Skills services to families with children, age birth to 18, as referred by the Department. 2. Services will include hands-on teaching of basic skills including, but not limited to,effectively accessing community resources, parenting skills, household management, and basic family conflict management. 3. Average length of services is four(4)to six(6) months. 4. CONTRACTOR has staff proficient in Spanish and American Sign Language. 5. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 6. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 8. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 9. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team (URT)and are not considered billable hours. 12 PY-12-13-CORE-0211 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $50.00/Hour(Life Skills) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 13 PY-12-13-CORE-0211 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program (PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 14 • PY-12-13-CORE-O211 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships(parent/child, sibling/sibling,extended family/child, etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 15 PY-12-13-CORE-0211 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORS can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator, the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 16 PY-12-13-CORE-0211 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11`h Avenue,Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 17 • PY-12-13-CORE-0211 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core &Service Contract Coordinator Date 18 •••- ,0 o Q r.. L • t s -. . e�. m,. . f C .. O) y i- E '- ..f.0...... 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" O z ° a u N o m , O V N • a E J t t, v c Z a 2 � vi i x v`"i Z r 1 PY-12-13-CORE-0147 ; ,...(0/ 2 c 1�, CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SAVIO HOUSE VI fi This Agreement, made and entered into the O day of h9 2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of Human Services, hereinafter referred to as the"Department"and Savio House, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS,required approval,clearance, and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Multisystemic Therapy/Multisystemic Therapy-Problem Sexual Behavior;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31, 2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 a0/a—aoC99 PY-12-13-CORE-0147 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement,CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations,including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et. seq.and its implementing regulation,45 C.F.R.Part 80 et seq.;and 2 PY-12-13-CORE-0147 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin,be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963; and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R.Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin, and sex,religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R.Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.5.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PV-12-13-CORE-0147 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3),if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law,(b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas,unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0147 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0147 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0147 b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: William S. Hildenbrand Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director William S. Hildenbrand, Executive Director P.O.Box A 325 King Street Greeley,CO 80632 Denver,CO 80219 1970)352-1551 1303)225-4014 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy,reorganization and/or foreclosure. 7 PY-12-13-CORE-0147 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities,rights, benefits,protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections, paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer,member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0147 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation,renewal,amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal, and state auditors and representatives shall,during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period,or if audit findings have not been resolved after a seven (7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CORE-0147 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those of its customers,clients or affiliates, but does not include information(1)lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0147 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTESTS W i ` i WELDBOARDOFNT ,CO COMMISSIONERS IONERS I � i ^ - \ WELD COUNTY,COLORADO Weld County Clerk to the Board al 61� ry e�` ggga � .v#2 Sean P.Conway,Chair AUG 0 8 2012 By: Deputy Clerk to a Board APPROVED AS TO FORM: L �%wzcYf_ County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES /0/,P114 / ,/,� / By: II..Iu . �L � By: %'4//�! l J d A.Grieg• Directo Contractor Title 11 2Y/oil cP PY-12-13-CORE-0147 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Multisystemic Therapy(MST)or Multisystemic Therapy-Problem Sexual Behavior(MST-PSB)services to youth ages 11-18,and their families,as referred by the Department. 2. CONTRACTOR will provide MST and MST-PSB in accordance with the National Multisystemic model and will comply with its standards and guidelines. CONTRACTOR is under the supervision of MST,Inc.,of South Carolina and the Center for Effective Interventions in Denver,CO. 3. MST is a short-term and goal-oriented treatment that specifically targets those factors in each youth's social network that are contributing to his or her antisocial behavior. MST interventions typically aim to improve caregiver discipline practices,enhance family affective relations,decrease youth association with deviant peers,increase youth association with pro-social peers,improve youth school or vocational performance,engage youth in pro-social recreational outlets,and develop an indigenous support network of extended family, neighbors,and friends to help caregivers achieve and maintain such changes. Specific treatment techniques used to facilitate these gains are integrated from those therapies that have the most empirical support including cognitive behavioral, behavioral,and the pragmatic family therapies. Each family referred for MST will receive 6.5 to 10 hours of service per week for approximately three(3) to five(5)months. 4. MST-PSB is a specialized,comprehensive MST program designed to meet the needs of juvenile sex offenders reintegrating into the community. Emphasis is placed on aspects of the youth's ecology that specifically relate to the youth's sexual delinquency and on the youth's peer relations so as to encourage age appropriate and normative sexual experiences. Each family referred for MST-PSB will receive three (3)to four(4)hours of service per week for approximately six(6)to eight(8)months,with a focus on caregiver participation. MST-PSB does not utilize group therapy. It is approved by the Sex Offender Management Board(SOMB)as a treatment modality. 5. CONTRACTOR has one(1)bilingual(Spanish)MST therapist. 6. CONTRACTOR will be available to referred families 24 hours per day/7 days per week via emergency pager or cell phone. 7. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 8. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 10. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12 PY-12-13-CORE-0147 11. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0147 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $1,670.00/Month(Multisystemic Therapy. Pro-rated for any partial month of service.) $2,537.00/Month(Multisystemic Therapy-Problem Sexual Behavior. Pro-rated for any partial month of service.) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 14 PY-12-13-CORE-0147 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program (PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-12-13-CORE-0147 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional, educational and behavioral well-being of the child. When appropriate,CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-12-13-CORE-0147 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided,unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based,etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 17 PY-12-13-CORE-0147 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date(appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only,should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1)monthly progress report submitted online(if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement),and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11`°Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CORE-0147 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services(Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core &Service Contract Coordinator Date 19 • • toN a 2 dcc4 - a0) < w � c :U 0 '- co>..-- ritim aO O e d V O -. R d G N . z O O O fw H 0 10.C7+....�. c'') v i5 r N 2'16 a= O7 m U N N � ' O _ C U O N N O ¢ x o , a (-) d N T a Ea O ct Z 46 d m o Z `O CK ❑ Ow 00 .� O U cu o O >>° ,D °) h- L U O ❑ co N -:.Q N Ze 8.' -0 N '0 _L...N. Lu n awea v u w @ v rn U m a) a @ o co o-� °3d '...Q Z ..'F- Q v 'n J CT t N N U a m 1n w « O J W U) z m xzad v co = m g ° ❑ oo a.) CC e d N N O 2 m LL ui n o J _ N c U N N N U � U '_ H a a co = 4 J La F 21 N « o Z U Iocc W Q °1 E we co .-.w L ( o w J E m z m _j o U ya 'o c a � � � m° c v y d a Q o n v Q o � .-- o_ a0 UIXfn ❑ § — . - ) 7 k m « .c o 2 117 k f 0 ' I to 0. o ® % j is , la \ / - ! C 2 I } O \ } { 9 ti § 2 O / $ t E H z ; $ Z — E ; 15• -Fs EIF, ) III> 2 § \ z 5 ] 6 / fe a in2 - / I ■ $ ta > � 8 a) 1o1 Ill § ] } } \ [To RI yr I r �• k k � 4 I 1.6 �ill E �O CIJ tt 2 w 5 \ k I 0 0 �@ 2 \ : 2 E LuILI - \ I g 1:1 Cg > 2 a.x . C E 8 0 a) E t • _ / - b = o § ( > \ 0 _ § § { / { 2 2 to 2 J � § f § E • - } � � 8 01 / } \ \ \ z ° }--- -- .2 0 0 a s5- oJ L+4 § / 3 I I k ! �to \ k \ I § V. Q = E J / 2 k \ \ _c \ 9 ® ` �% 1 .ii A � 0 ; a > R � k § 2 2 - a 41 U § & / \ O k\ ] d oe e = \= o ,I $ � d a / ' k k \ I ` a | o_ z \ ,X » ) § } \ I I ■ 2 r% riP afret PY-12-13-CORE-0193 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SHILOH HOME,INC. This Agreement, made and entered into the _7_day of 2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of Human Services, hereinafter referred to as the"Department"and Shiloh Home,Inc.,hereinafter referred to as the "Contractor". WITNESSETH WHEREAS,required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Day Treatment Services;and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1.2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Trackinq CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B'Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 (320 io7— °°e<3'9 r PY-12-13-CORE-0193 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement,CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations,including,but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards,regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 a seq.and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-O193 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin,be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq. and its implementation regulations,45 C.F.R. Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986,P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex, religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal background record checks for all employees, CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement,been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 , PY-12-13-CORE-0193 iv. Have not,within a three-year period preceding this Agreement,had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law,(b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety,Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas,unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0193 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals,insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0193 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0193 b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Steven Ramirez Chief Executive Officer Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Grieco, Director Steven Ramirez,Chief Executive Officer P.O. Box A 6400 West Coal Mine Avenue Greeley,CO 80632 Littleton,CO 80123 (970)352-1551 (303)932-9599 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy,reorganization and/or foreclosure. 7 PY-12-13-CORE-0193 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities, rights, benefits,protections or other provisions,of the Colorado Governmental immunity Act 4424-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0193 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal,amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven (7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection,no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CORE-0193 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets,business affairs, internal operations and management procedures and those of its customers,clients or affiliates, but does not include information(1)lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0193 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO Weld County Clerk to the Board a ,` Sean P.Conway,Chair AUG 08 2012 By: Deputy Clerk to he Board APPROVED AS TO FORM: C (ltrcJ� County Attorney WELD COUNTY DEPARTMENT CONTR R: OF HUMAN SERVICES By: By: J A.Griegq, D ector Co tractor Steven E. mirez/CE( C � Title 11 ao/. -ae,S9 PY-12-13-CORE-0193 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide day treatment services to youth,ages 7-18 years of age with behavioral disorders, mental health issues and sex offending issues,as referred by the Department. Referred youth and family must be proficient in English. 2. Services are available in Littleton,CO,at 6884 S.Marshall Street,or in Longmont,CO,at 745 Highway 119. 3. Services include: a. Educational,psychological and clinical assessment services b. Offense specific treatment services c. Individual (weekly),family(weekly),group(weekly)and milieu therapies(daily) d. Case management e. Academic curriculum credits transferable to public school f. Special education services g. Transportation to and from school(within a 15-mile radius) h. In-home services(case-by-case basis) i. Community activities j. Monthly progress review k. 24/7 on-call assistance I. Random urinalysis m. Transitional services to public school n. Monthly progress reports to include ongoing assessment of family o. Transitional services/staffing to public school 4. Services are specifically designed for those youth who demonstrate a pattern of maladaptive behaviors that interfere with their adaptive community functioning and who are not at greater risk for out-of-home removal. 5. The program focuses on skills development where the youth recognizes their maladaptive behaviors and associated thinking errors,and where the use of greater repertoire of positive social skills and adaptive coping skills is supported. Newly acquired skills are practiced in the program,in group therapy with their family and in the community at large. 6. Group counseling is offered daily and is facilitated at least twice per week by a master's level clinician. Groups address a variety of issues, including independent living skills,coping skills/tools,social skills and cognitive restructuring. Clients are taught accountability,self-monitoring and improved self-control,as well as decision making skills. 7. Individual therapy is offered weekly and facilitated by a master's level clinician. 8. Recreational activities are scheduled regularly based upon the client's interests and needs,as well as available community resources. 9. Progression through the program is assisted through a feedback system in which the youth's behavior and quality of work on phase projects in the program and at home is tied to program privileges. Additionally, positive progression is measured by successful completion of written and behavioral assignments,and the development of a relapse prevention plan. 12 PY-12-13-CORE-0193 10. Referred youth and adolescents with severely limited cognitive abilities(IQ below 65),ongoing medical issues that cannot be supervised/managed by staff,an inability or significantly impaired ability to understand and/or communicate in English,and those who are actively psychotic are generally not considered appropriate for this program. 11. CONTRACTOR administers program year round,minimum of six(6)hours per day,five days per week (excluding holidays and teacher in-service days). 12. CONTRACTOR has identified the following performance outcomes: a. Successful transition to public school upon completion of program. b. Successful completion of GED when indicated. c. Client will remain in the caregiver home or less restrictive setting after discharge. d. Academic improvement as evidenced by Wide Range Achievement Test(WRAT),which will be administered at intake and discharge. e. Client and caregivers will be linked to identified community resources(mental health,medical, dental,community support,etc.)prior to discharge. f. Caregivers will increase parenting competency as evidenced by parents ensuring a safe environment that is free of present dangers or impeding threats. g. Caregivers will demonstrate compliance with Informed Supervision Criteria(if applicable). 13. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 14. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 15. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 16. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. 17. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0193 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2,below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $1,625.00/Month(Pro-rated for any partial month of service.) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7"h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 14 PY-12-13-CORE-0193 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.' The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers'protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential,prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-12-13-CORE-0193 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. 'Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-12-13-CORE-0193 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided,unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received,carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.)are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 17 PY-12-13-CORE-0193 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date(appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online(if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement),and 3)Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11'h Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CORE-0193 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services(Program Area): "Service Month/Year: Charges: $ `Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 19 di itt . . 2. +«m 45 d\?$• 45.13-t-y 0. P. / tt / \ / & 2 : hiii : . . ±Eqt'Vy« % @ a JaIn IoD N ) S \ ) ) ` 0 J + #eI O 7 \tk /\ S . 2 CO _ - N z ! § a) L• - § A <W {7 § \ w k k; ! ) O 2 »« ! 7 in < r jID�o k � � U Z t + zE7 0 � �To g � Co § _ E l § * | / _ » m 7 { < \ / { o \ ! \ / L ) z ® ® ° Co\ w k \ ■ EC rh § k § � k f}� i = a2a N u. ± - J2y ± - & a to c k k c g \ II01 13 ho 5 / � g oo te - � ) $ � � & Zfo / 7C Z � �cr .0- 2 { .- in ■ f ] \ _ « U § § I § $ 1 ) ` CO f ■ § ` E x 2 7 z � � _ . ; } 2u k � I- ` - ' T. $ § # z a 5 . § q @ § > | # © $ ` i4 M o f B & § a 60 _ § d _ \ to « 0 rsi C, in \ i § : 2 $ o % > k \ / \ 42 § @ l H ( lat 0b I { I f ti Z.-; 4 Jaio 0 $ ( & \ / 9 '0 $ § ) \ in % k \ % C E = } f ! tt < g 41 . l'.," > c I a § . . . \ � � § a U0 ) 7 g 5 m kT, § 20 0.Io I \ ■ .0 2 2 \ § ) k � \ } 2 . - at 9 tei f a I. ®� e § $ 2 ] •& a E . 1 E »..,t! \ $ g l ] a at ri e \ = %§ © & \ Z" ± § § r a• z = k } } k ) �. 1 PY-12-13-CORE-0213 PAC CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SHILOH HOME,INC. This Agreement, made and entered into the day of�l�/r/2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,orf behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and Shiloh Home,Inc.,hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Mental Health Services;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 026 _cQo g t PY-12-13-CORE-0213 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement,CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including,but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards,regulations,interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et.seq.and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-0213 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 a seq.and its implementation regulations,45 C.F.R. Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex,religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.5.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended, proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. H. Have not,within a three-year period preceding this Agreement,been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 • PY-12-13-CORE-0213 iv. Have not,within a three-year period preceding this Agreement,had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and (c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0213 Agreement. CONTRACTOR shall indemnify, defend,and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement,it has currently in effect all necessary licenses,approvals, insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0213 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0213 b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Steven Ramirez Chief Executive Officer Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Steven Ramirez,Chief Executive Officer P.O. Box A 6400 West Coal Mine Avenue Greeley,CO 80632 Littleton,CO 80123 (970)352-1551 1303)932-9599 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0213 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental immunity Act§424-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection,paragraph,sentence, clause,and phrase thereof irrespective of the fact that any one or more sections,subsections, paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer,member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0213 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation,renewal,amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven(7)year period, or if audit findings have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents, and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CORE-O213 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those of its customers,clients or affiliates, but does not include information(1)lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0213 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: ` //: s ,. ,� - BOARD OF COUNTY COMMISSIONERS l ...��"�� WELD COUNTY,COLORADO ra Weld County Clerk to the Board .1361: . f " Sean P.Conway,Chair AUG 0 8 2012 By: Deputy Clerk to e Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT CONTRACTO . OF HUMAN SERVICES �{ By: By: r 69..44404- S u A.Grit, Director Contractor Steven E. R . rez/CEI Title\ 11 11 070/0— C dC7 • PY-12-13-CORE-0213 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Mental Health Services to youth,and their families, who speak English. In situations in which a family member does not speak English,CONTRACTOR will provide an interpreter for the primary language of the family member. 2. Services will be available at the following locations: a. 2700 E.Ken Pratt Boulevard, Longmont,CO 80501 b. 8461 Delaware Street,Thornton,CO 80260 c. 6350 West Coal Mine Avenue, Littleton,CO 80123 d. 7400 Kearney Street,Commerce City,CO 80022 3. Services will utilize the following evidence-based treatments: a. Cognitive Behavioral Therapy(Correcting thinking errors; linking thoughts,feelings and behaviors; and teaching new,healthy empathic and reality-based ways for thinking.) b. Behavioral Therapy(Teaching and rehearsing healthy ways to behave when overwhelmed by feelings and perceived needs.) c. Psycho-education and Family System Theory(Stabilization of the client's mental health diagnoses.) 4. Available services include: a. Individual Therapy: Addresses the impact of mental health disorders,works to lessen the effect of disorders and restores the client to the best possible level of functioning,and facilitates recovery. b. Family Therapy: Focuses on improving communication,increasing family member's level of differentiation and creating a better functioning home environment. c. Group Therapy: Addresses a variety of issues,symptom management,family issues, anger management,self-esteem,social skill, independent living,coping skills and cognitive restructuring. d. Crisis Intervention: Available as needed to assist individuals in dealing with unexpected situations that may arise between therapy sessions. e. Community Resources: Links referred youth and family with community services that may be beneficial or that are not provided by CONTRACTOR. An aftercare plan will be provided that outlines ongoing services to ensure youth is maintained successfully in the family home. 5. Services will be provided by either a licensed clinician or a Master's level clinician supervised by a licensed clinician. The frequency of therapy will be determined at the time of referral and assessment,and sessions will be offered throughout the day and evening to accomadate working family members. 6. CONTRACTOR will develop a comprehensive service plan during the intake process. The plan will identify the goals for successful completion of treatment and a plan for a system of care following completion of treatment. 7. Performance Outcomes: a. Youth will improve and manage their presenting problems areas. b. Family participation as measured by caregiver's attendance in sessions and level of participation. c. Caregivers will maintain a safe and stable home environment for youth and other family members. d. Youth will be maintained safely in their home when possible and appropriate. e. Continuity of family relationships and connections will be preserved by identifying barriers and providing appropriate interventions. f. Caregiver will gain the capacity to provide their children's education and mental health needs on an on-going basis. 12 PY-12-13-CORE-O213 8. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to,any physical,emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 11. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. Monthly reports will address the following: 12. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 • PV-12-13-CORE-0213 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2,below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $95.00/Hour(Family Therapy-In-home) $75.00/Session(Family Therapy-In-office) $75.00/Hour(Individual Therapy) $45.00/Session (Group Therapy) $90.00/Hour(Psychological Evaluation) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PY-12-13-CORE-0213 b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 PY-12-13-CORE-0213 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers'protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-12-13-CORE-0213 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional, educational and behavioral well-being of the child. When appropriate,CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-12-13-CORE-0213 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided,unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information,client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services(visitation,therapy, home-based, etc.)are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy),each member should sign the same form at the time of service. 18 PY-12-13-CORE-0213 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months,and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement),and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-12-13-CORE-0213 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAWAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core&Service Contract Coordinator Date 20 a; o O Q N a C w N• E r co .. N N C. N Q N v O °0p G) NN -:, ° �U o ( aao°c'4A •-• wooco .>o aaca� EO �ico a) j .. in N @ `y O cc,' "-• U_ NI • J C ` CC o O = a) N O Qso� a I H N v y N h- Z O O Z O 0 o w o 0 0 U `) ad m ri L U O Q CO N N z tZ av1r, a`> o CO 2w ¢wca? CO w m > N r. o J O d N N_ amw a> a.. m CI Q (no 2 (° Z Q -o in J O in e n U N X t 3E .- `yLn w Wt Z 2Za132 CO _To �. E 0 CO U Q 2 N N CO a) J t. w "O E n W bp d se > ~ N Q I 9 X O E } w a> } w U d —I a a c � Z n> ^ Z 0 > 0 o E Z U = `ow Q ° E we N U d d m m as m a } a � cCw a0 0c[ 00 \ } CD CO { O O IO o { / ! )En CV \ - 7 } / f ! Z « i } ] •-• To n; | � , § | V _ % I & / §m ■ _ $ ) - ; ) tozi | § ! e. 7 ; iv _ , cc w ct 1.1 } ! } : 2 Lu > * ) ) ta | 0LI e \ / - : � - a 13 .0 § 7 \ # ) f \ \ % - : t \ & ! to o § � o § \ ) \ ! \ / en 2 � { { � — ) k / / iv-ii o. : k ! ( - ® - ■ | 20 0 { ! - = k § ) } ) \ \ § | � 3 , . i = - 'Al} ! ! r 4i _ ..I W/ i i r'; ii PY-12-13-CORE-0212tir z� t CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SHILOH HOME,INC. J This Agreement,made and entered into the day of '/q,2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,oy behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and Shiloh Home,Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Sexual Abuse Treatment(Offense Specific Services);and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1.2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization,billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. S.,/ -u ... tai. tw., 1 (9r/,5?-- 2)89. • PY-12-13-CORE-0212 1 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including,but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement,CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards,regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et.seq.and its implementing regulation,45 C.F.R.Part 80 et.seq.;and 2 PY-12-13-CORE-0212 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84;and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq. and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race, color,National origin,and sex,religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement,been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal,state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CORE-0212 iv. Have not,within a three-year period preceding this Agreement,had one or more public transactions(federal,state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a) has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.5.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law,(b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety,Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas,unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0212 Agreement. CONTRACTOR shall indemnify, defend,and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease,covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement,it has currently in effect all necessary licenses,approvals, insurance,etc.,required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. S PY-12-13-CORE-0212 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0212 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Steven Ramirez Chief Executive Officer Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego,Director Steven Ramirez,Chief Executive Officer P.O.Box A 6400 West Coal Mine Avenue Greeley,CO 80632 Littleton,CO 80123 1970)352-1551 1303)932-9599 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0212 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities,rights, benefits, protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences, clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0212 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation,renewal,amendment,or modification of any Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven(7)year period,or if audit findings have not been resolved after a seven (7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection,no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees,agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CORE-0212 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets,business affairs, internal operations and management procedures and those of its customers,clients or affiliates, but does not include information(1)lawfully obtained from third parties, (2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0212 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. .. ATTEST ti `W- BOARD OF COUNTY COMMISSIONERS �., , -WELD COUNTY,COLORADO Weld County Clerk to the Board * ! Jl`¢ 0 ,,, • y Sean P.Conway,Chair AUG 0 8 2012 By: Deputy Clerk t the Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT TRACT R: OF HUMAN SERVICES By: r--) By: 4,A-44 y .Griego, irector Co ractor Steven E. irez/C Title 11 PY-12-13-CORE-0212 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Sexual Abuse Treatment(Offense Specific Services)to youth,ages 7 to 19,and their families,who speak English. In situations in which a family member does not speak English, CONTRACTOR will provide an interpreter for the primary language of the family member. 2. Services will be available at the following locations: a. 2700 E. Ken Pratt Boulevard, Longmont,CO 80501 b. 8461 Delaware Street,Thornton,CO 80260 c. 6350 West Coal Mine Avenue, Littleton,CO 80123 3. Services will utilize the following evidence-based treatments: a. Cognitive Behavioral Therapy(Correcting thinking errors; linking thoughts,feelings and behaviors; and teaching new, healthy empathic and reality-based ways for thinking.) b. Behavioral Therapy(Teaching and rehearsing healthy ways to behave when overwhelmed by feelings and perceived needs.) c. Psycho-education and Family System Theory(Stabilization of the client's mental health diagnoses.) 4. Services will be provided by either a licensed SOMB clinician or a Master's level clinician supervised by a licensed SOMB clinician. All therapy adheres to the Colorado Sex Offender Management Board(SOMB) Standards and Guidelines for the Evaluation,Assessment,Treatment and Supervision of Juveniles. 5. The frequency of therapy will be determined at the time of referral and assessment and will be offered throughout the day and evening to accommodate family schedules. 6. Offense Specific Treatment Objectives: a. Completion of a comprehensive intake assessment to include identifying relationship concerns and/or barriers to achieving treatment goals. b. Ongoing assessment of functioning evident in client,family and therapist feedback. c. An initial treatment plan developed with family,caseworker and CONTRACTOR. d. Ongoing review and modification of treatment plan monthly to include ongoing assessment of risk and safety concerns,and the interventions to address any identified concerns, recommendations for service and/or safety measures to ensure safety of the client. e. Consistent participation in scheduled individual,family and group sessions. f. Functional change in family that does tolerate abusive behavior. g. Evidence of abuse-free functioning by displaying appropriate and pro-social behavior in sessions and in the home. h. Recognition of harm done to victim(s). i. Implementation of relapse prevention plan. j. Acceptance of responsibility for abusive behavior without blame or externalizing. k. Overview of interventions/progress/ongoing needs. I. Recommendations of completion of treatment. 7. Offense Specific Treatment Goals: a. Full disclosure of abusive behavior. b. Full disclosure of own victimization. c. Ability to understand personal cycle of abuse,as well as ways to avoid maladaptive thoughts,feeling and behavior. d. Behavioral stability evident in consistent display of safety toward self and others and respect toward property. e. Development of parent-child relationship and home environment that supports abuse-free functioning and does not tolerate abuse behavior. 12 PY-12-13-CORE-0212 f. Development of a relapse prevention plan that matches abusive behavior. g. Recommendations upon completion of treatment to include ongoing needs and supports to increase likelihood of success to ensure youth maintain in the home. 8. Performance Outcomes: a. No sexual recidivism. b. Completion of Sex Offender Management Board(5OMB)standards. c. Increased parenting competency as evidenced by parents ensuring a safe environment that is free of present dangers and impending threats. d. Parental compliance with Informed Supervision criteria. e. Successful completion of victim clarification if appropriate measured in conjunction with the victim's therapist. f. Maintenance in the community(home,job,public school). 9. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 10. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 11. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. Monthly reports will address the following: a. Assessment of risk and safety concerns and the interventions to address any identified concerns. b. Recommendations of services and/or safety measures to ensure safety of the client. c. Efforts attempted to engage families in counseling services. d. Goals revised/updated to include clear and measurable objectives with timeframes. 13. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0212 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2,below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $95.00/Hour(Family Therapy-In-home) $75.00/Session(Family Therapy-In-office) $75.00/Hour(Individual Therapy) $45.00/Session (Group Therapy) $90.00/Hour(Psychological Evaluation) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible,but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PY-12-13-CORE-0212 b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 PY-12-13-CORE-0212 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families, For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORS. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORS should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers'protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential,prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-12-13-CORE-O212 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate,CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. "Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-12-13-CORE-0212 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received,carefully review the referral for service information,client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based,etc.)are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 18 PV-12-13-CORE-0212 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date(appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only,should not cross months,and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online(if applicable to the service provided),2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3)Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-12-13-CORE-0212 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAMMAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAWAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core&Service Contract Coordinator Date 20 \®0 a f\±: re) \ , «# * :t7\\ \ f ,R a - d / »/\ :% # a { § & \ ) L) & \ N LO CD N ) r / < i Qo. u / / k /§ e 43 4= u | . 2 2 © ^ - . § z § }t � / = IA »I {t O § 6t « r -- a .. . g 33f Q -J W 0 LO 0 « LO 6 = ! ■ » ) Z % + 2E7 § ) \ co —O ` a I ■ { / a) "6 cii \ � ` ni ) q ) \ z ( ( Q _J { L ) re © ® I- t ® ° kf ■ Ec § i2 & f h.) } § ) { /\ \ } 7 } f ' ' ra S c ! \ } � $ \ t \ \ \ $ \ / ar too \ LD k1- E— / { I"; a ! \ f 03 = _ ■ / a / / \ \ « | { ( ci « a ■ _ 0 } § b \ - / sr c _ _ - w \ : C f ( ( 2 *74 k ( $ ■ e / , , oat U ` �CC La S ( •` ! \ § ) / _ ( k . ( , Au § § { ei / cat u � _ w kk { } -c, c. } ; 2 ! \ rn { \ a icj 19 to ! f vn « ) % - re .ie \ b 01 uo $ & & ) « ; $ ni ? \ TI cE1 :g / a , � ` § ` 533 2, ' $ oa ; ) &4 S k } 0 ` -ji; 11 } j ) ` i\ el } \ k k ) § }\ LI Oeft3/0 PY-12-13-CORE-0208 aftt CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT,INC. This Agreement, made and entered into the 2''day oLTz-.J , 2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of Human Services, hereinafter referred to as the"Department"and Turning Point Center for Youth and Family Development, Inc.,hereinafter referred to as the"Contractor". WITNESSETH WHEREAS, required approval, clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Home Based Intensive Services(Coaching,Option B);and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2012 upon proper execution of this Agreement and shall expire May 31,2013 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D"Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. y SE 'G -.3 Z ii Lit.( 1 02D/02-aDS'? PY-12-13-CORE-0208 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7"'day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7, Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et.seq. and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-0208 • All provisions of Civil Rights Act of 1986 so that no person shall,on the grounds of race,creed, color,se,or national origin, be excluded from participation in, be denied the benefits of,or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq. and its implementation regulations,45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967;and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin, and sex, religion and handicap,including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible, as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal, state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification;and 3 PY-12-13-CORE-0208 iv. Have not,within a three-year period preceding this Agreement,had one or more public transactions(federal, state,and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and (b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3),if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor,it hereby sears or affirms under penalty of perjury that is(a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law,(b)shall produce one of the forms of identification required by C.R.S. 24-76.5-101,et seq., and (c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR,its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0208 Agreement. CONTRACTOR shall indemnify, defend,and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business,at its own expense, and maintain for the duration of the work,the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability(PL and PD) (Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals,insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0208 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0208 b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Stephanie Brown Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Stephanie Brown, Executive Director P.O. Box A 1644 South College Avenue Greeley,CO 80632 Fort Collins,CO 80525 (970)352-1551 1970)567-6461 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation" includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0208 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied, of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections, paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0208 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement,and the extension, continuation, renewal,amendment,or modification of any Federal contract, loan,grant, or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall, during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR,in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-12-13-CORE-0208 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those of its customers, clients or affiliates,but does not include information(1)lawfully obtained from third parties, (2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0208 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS " WELD COUNTY,COLL,,OORRAADO V Weld County Clerk to the Board Sean P.Conway,Chair ,�� AUG 08 2012 By: / Deputy Clerk to / e Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUM SE ICESSA . By tit By: acs) Judy A. riego, Dir or on actor erart Title 11 PY-12-13-CORE-0208 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home Based Intensive Services to individuals and families in Weld County referred by the Department. Services include Coaching and Option B services. 2. Coaching services can include, but are not limited to,the following: a. In-home parenting support and education. b. Assistance with appointments. c. Engaging child or youth in recreational and leisure activities in the community. d. Supervision of child or youth while parents or caregiver is unavailable. e. Assisting youth with job searches. f. Mentoring and positive role modeling. g. Connect child and/or youth and family with community resources. h. Assist with housing issues. i. Homework assistance and tutoring. j. Lifeskills coaching and education. 3. Option B services are designed to provide therapeutic support clients and their families in the least restrictive, most appropriate setting.Services will include intervention that combine strength based, solution focused,family systems and cognitive behavioral to promote pro-social behaviors and increase functional behavior. 4. CONTRACTOR will work with the Department to appropriately modify services as needed to meet client(s)needs. 4. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 5. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 6. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 7. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 8. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team (URT)and are not considered billable hours. 12 PY-12-13-CORE-O2O8 EXHIBIT B PAYMENT SCHEDULE • 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31,2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $25.00/Hour(Coaching) $80.00/Hour(Option B-Greeley Metro Area to include Greeley, Eaton, Evans, La Salle, and Windsor) $120.00/Hour(Option B-Outside Greeley Metro Area) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 13 PY-12-13-CORE-0208 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program(PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social, emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 14 PY-12-13-CORE-0208 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional,educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 15 PY-12-13-CORE-0208 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided,unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 16 PY-12-13-CORE-0208 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex,Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only,should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2)the billing documents(Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 17 PY-12-13-CORE-0208 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core& Service Contract Coordinator Date 18 co > @ / - / a) \ , E co - » k ea 76° < t� §7 � / 3k $ gGC0 �O � 0 �t > E .- � id - I- a� kmx � d $ -M' E > -0asCa2 �� 3GE R . q a $ E � § b@r- r § � 2 6 S u)e05Iao �f 2Q ■ �. n I m o 7 � Ce 0_IoD u) S = , 2 E ' cl D _ $ •E 0 / fb@I / 'Jr; / ,-q ? a9 7 I- 2 3 * $ / E % 0 % n E ■ "O @ CII / / 0 / 0 , \ 2 22 a= � � G 2 Cl) I $ a3 �7 % v I - 5 � « co u > a Cl) �te � N- 0_ k aa ® R o < _ 0 o z . R < = tn 2 a 7) w t @ - S \ e § E w ' 2 7 I2 - e n i_ m 0 co § cc eI 7 k02t Co � < ui / 7 22 / k k � o ti \ < \ R � 9 \ k >: w & Qou a I- cc "\ 0 Q6 o z o V § 2w � � b LI�LU -C Q / 2Q_ § f 220_ v-I2 $ ,.Q \ / a a kI - 0- O OU)0 a. Ltt \ ) % |CO in i t\ \ \ \ \ \ 6E ) | ir in2 : 2 / \ \ � \ L \_ CU bp \ ( § ) — via)`0. - , � 'n cc tu \ \ 0 \ \ in O - � _ _ \ \ \n\ E \ \ \ / \ \ _ \ 4. = � C77 C .17 \ } \ \ § \ \ f — \ ) Cr, \ \ - - \ \ }\ ) k } ) \ \ \ ) ( fl ) | G'7Do/ PY-12-13-CORE-0175 . CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT,INC. This Agreement, made and entered into the Z7 day of�i—' ,2012, by and between the Board of Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department"and Turning Point Center for Youth and Family Development, Inc.,hereinafter referred to as the"Contractor". WITNESSETH WHEREAS, required approval, clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Service has provided Core Services to the Department for Day Treatment Services;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012, upon proper execution of this Agreement and shall expire May 31,2013, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/TrackinR CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D"Process Reference Guide",of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B"Payment Schedule,"of which are attached hereto and incorporated herein by reference. "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 020/0,— eVS PY-12-13-CORE-0175 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for,and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement,CONTRACTOR shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives,contractual terms,or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations,including,but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws,orders,and all applicable standards, regulations,interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents,tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et.seq. and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-O175 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race,creed, color,se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C.Section 794,and its implementing regulations,45 C.F.R. Part 84; and • the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et seq.and its implementation regulations,45 C.F.R. Part 91;and • Title VII of the Civil Rights Act of 1964;and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963;and • the Education Amendments of 1972;and • Immigration Reform and Control Act of 1986, P.L.99-603 • 42 C.F.R. Part 2;and all regulations applicable to these laws prohibiting discrimination because of race,color, National origin,and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible, as sources of supplies, equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees,CONTRACTORS,and sub-contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a federal department or agency. H. Have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (federal, state or local)transaction or contract under a public transaction;violation of federal or state antitrust statues or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-12-13-CORE-0175 iv. Have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state, and local)terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.)8-17.5-101,et.seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents,warrants, and agrees that is(a) has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S.8-17.5-101,et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement,CONTRACTOR must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-76.5-103(4)if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is(a)is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b)shall produce one of the forms of identification required by C.R.S.24-76.5-101,et seq., and (c)shall produce one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s)identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas,unless otherwise determined by the Department. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor,or their employees,volunteers,or agents while performing duties described in this 4 PY-12-13-CORE-0175 Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld County, its employees,volunteers and agents. Therefore,CONTRACTOR shall provide adequate liability(including professional liability insurances where necessary)and worker's compensation insurances for all its employees,volunteer,and agents engaged in the performance of the Agreement. Upon request,CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum,CONTRACTOR,shall procure,either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work,the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance,where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability(PL and PD)(Minimum). o Combined single limit-$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than$1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below$500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability(Minimum)for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that,at the time of entering into this Agreement, it has currently in effect all necessary licenses,approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-12-13-CORE-0175 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-12-13-CORE-0175 b. Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Administrator Name Title For Contractor: Stephanie Brown Executive Director Name Title 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Stephanie Brown, Executive Director P.O. Box A 1644 South College Avenue Greeley,CO 80632 Fort Collins,CO 80525 (970)352-1551 1970)567-6461 18. Litigation CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term "litigation"includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-12-13-CORE-0175 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental immunity Act§§24-10-101 et seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections, paragraphs,sentences, clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer,member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-12-13-CORE-0175 submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an agency,a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any federal grant,the making of any federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, loan,grant, or cooperative agreement. 24. Storage,Availability and Retention of Records CONTRACTOR agrees that authorized local,federal,and state auditors and representatives shall,during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications,and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request,for a period of seven (7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven (7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information. CONTRACTOR shall advise its employees,agents, and sub-contractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents,and sub-contractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 9 PY-12-13-CORE-0175 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those of its customers, clients or affiliates,but does not include information (1)lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of the execution of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-12-13-CORE-0175 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. i ATTEST: - ` id) BOARD OF COUNTY COMMISSIONERS ✓ ,8 WELD COUNTY, COLORADO Weld County Clerk to the Board \1%6‘0;,:*:. ) �" \ yi A. Sean P. Conway,Chair U AUG 0 8 2012 By: Deputy Clerk the Board APPROVED AS TO FORM: tit r iir„,...f County Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: B J A.Grie o, Direct Col rector Title 11 070/x -( S9' PY-12-13-CORE-0175 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide comprehensive,highly structured day treatment services,as proposed,to female and male youth,ages 10-18, as referred by the Department. 2. CONTRACTOR will provide day treatment services,as proposed, at 913 11th Avenue, Greeley, CO 80631,8:30 a.m.to 4:30 p.m., Monday through Friday. 3. CONTRACTOR is licensed by the Colorado Department of Human Services State Child Care Licensing. License number 1553624. 4. Admission criteria include: a. Adolescents between the age of 10-18, male or female. b. Youth's needs cannot be met in a less restrictive environment due to emotional,family, behavioral, mental health,gang,legal and/or substance abuse issues. c. Youth is motivated and willing to participate in the program. d. Low to normal range of cognitive functioning. Cognitive levels will be assessed on a case-by-case basis. e. History of school failure and/or truancy. f. Family is willing to participate in treatment. 5. Teacher/Student ratio is 1 to 10. 6. Testing and psychiatric medication evaluations and appointments will be conducted as needed to aid in case planning and ensure the appropriate treatment is utilized for the referred youth's maximum growth and benefit. 7. Services will be provided by Masters'level therapists. 8. CONTRACTOR will utilize a bilingual Spanish interpreter when needed. 9. Referred youth will receive services for approximately four(4)to six(6)months. Length of services is dependent upon the referred youth's daily/weekly progress,individual/family needs and availability of funding.Services will include the following as appropriate: a. 30 hours per week of education approved by the Colorado Department of Education. b. Weekly individual therapy. c. Weekly in-home family therapy. d. Weekly drug and alcohol groups. e. Weekly skills group. f. Weekly community NA groups. g. Daily recreation activities. h. Vocational education. i. Affective education. j. Transition Services(Connections Program). k. Door to door transportation to and from program. 10. CONTRACTOR agrees that each referred client will be given the initial 10 days after intake to settle in without an attendance requirement. Following the initial 10 days,any five(5) unexcused absences in a 30-day time frame would necessitate discharge. 12 PY-12-13-CORE-0175 11. CONTRACTOR will provide Transition Services(Connections Program)through a Department of Education. This program allows CONTRACTOR to provide ongoing services and case management for the client and family following discharge from services. 12. CONTRACTOR will provide individual,group and/or family therapy to all referred youth unless otherwise directed by the Department. 13. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 14. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 15. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 16. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 17. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0175 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2013. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $89.00/Day(Day Treatment with In-home Family Therapy) $79.00/Day(Day Treatment without In-home Family Therapy) $65.00/Day(Day Treatment-Transitional Services. Only used for clients transitioning to public school.) CONTRACTOR may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s)indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PY-12-13-CORE-0175 b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 PY-12-13-CORE-0175 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program (PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats,and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential,prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-12-13-CORE-0175 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child, etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate,CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-12-13-CORE-0175 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 18 PY-12-13-CORE-0175 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7`" of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online(if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3)Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-12-13-CORE-0175 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month /Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. 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